The Five Organs Network of Traditional Chinese Medicine

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From Zhou Xuehai, Reflections Upon Reading the Medical Classics (Du Yi Suibi), ca. 1895:

The physician who knows how to harmonize the liver knows how to treat the hundred diseases.

From Tang Rongchuan, A Treatise on Blood Disorders (Xuezheng Lun), 1884:

Spreading is the nature of wood. The transformation of food qi relies entirely on the spreading and dredging function of liver wood once the food enters the stomach. If the liver's pure yang does not rise, it cannot spread and dredge the grain and fluids, and distention and discomfort in the middle region will inevitably result.

The liver is associated with wood. Wood qi is characterized by its upward momentum and its innate desire to be straight. As long as the flow of liver qi is not impeded, the blood vessels will remain open and unobstructed.

The liver is the organ that is in charge of storing blood. It also commands the ministerial fire (xiang huo). If there is sufficient blood, this fire will be warm but not fierce. As a result, the blood can circulate smoothly through the body's three burning spaces; it will reach the pores, and every single place in the body will benefit from its warming and nourishing function.

From Zhang Xichun, Chinese at Heart But Western Where Appropriate: Essays Investigating an Integrated Form of Medicine (Yixue Zhong Zhong Can Xi Lu), 1933:

Liver and spleen function together by assisting each other. However, people are always quick to point out that an excess of liver wood can injure the spleen earth, and thus have a detrimental affect on the proper digestion of food. But nobody seems to pay attention to the fact that a weak liver cannot circulate the spleen qi and thereby also cause maldigestion. Below, the liver connects to the Sea of Qi [lower dantian, associated with the kidney], which means that the liver is closely associated with the body's ministerial fire. It can utilize the power of this fire to produce earth. The food which enters the spleen and stomach relies on this power to be 'cooked.' This is what is meant by saying that the liver and the spleen function by assisting each other.

From Ye Tianshi, A Handbook of Clinical Case Histories (Linzheng Zhinan Yian), 1746:

The liver is known as both the wood organ and the wind organ. Because it houses the ministerial fire within, we can say that the structure of the liver is yin while its function is yang. Its nature is firm and resolute, and it is in charge of moving and ascending. The liver relies entirely on kidney water to sustain it, on blood to moisten it, on lung metal's clear nature and descending function to keep it in check, and on the generosity of the middle palace's earth qi to nourish it. In this way, a firm and unrelenting character is being fitted with a soft and harmonious body, resulting in the liver's balancing and free flowing nature.

From Zhang Huang, A Compendium of Illustrated Texts (Tushu Bian), Ming Dynasty:

The liver is associated with wood. It stores the blood and is the home of the hun spirits. Among the seven human emotions, only anger is of an intense nature. It dries up the blood and dissipates the hun spirits. The person who understands the way of nourishing the liver, therefore, never throws fits of anger.

From Yu Bian, Medical Teachings Continued (Xu Yishuo), 1522:

The Classic of Sagely Benefits states: 'The seasonal cycle of transformation begins with the wood phase. In the body, therefore, the process of germinating and nurturing the twelve channel systems is initiated by the liver. During the first month of pregnancy, for instance, a woman's fetus is nourished by her jueyin liver network.' The liver, therefore, marks the beginning of cyclical action, the stirring of spring yang which all living things rely upon as a catalyst for their growth. By avoiding outbursts of anger and by fostering this particular type of yang energy, your prenatal qi will keep generating forever. The liver is also in charge of color; if its qi is in harmony, the body will exhibit a healthy luster. If its qi is injured, the body will appear dry and brittle. Nourishing the liver, therefore, first of all means to refrain from anger. This is the key for the maintenance of good health.

From Yang Jizhou, The Great Compendium of Acupuncture and Moxibustion (Zhenjiu Dacheng), ca. 1590:

The eyes represent the orifices of the liver. When a person closes his/her eyes and falls asleep, the blood returns to the liver. From there it is transmitted to the eyes, and the ability to see results from this. When a person sleeps, now, the nameless fire within grows dim in order to revitalize. Although it may be impossible to refrain from sleeping altogether, it is advisable not to just let this energy dissipate for the mere sake of falling into a slumber.

Insomnia caused by a cold deficiency pattern of the gallbladder is accompanied by symptoms of restless thought and a sensation of extreme mental weariness. Excess heat in the liver will typically cause a person to sleep too much, resulting in the mirror of intelligence gathering dust and a deterioration of the root of good health. None of these conditions, obviously, are the result of proper nourishing of the liver and gallbladder nor an appropriate way of subduing the sleep demons.

This is what you should do: do not get angry, do not lay down during the day, and always retire your body but not your shen. The essence of sleep, after all, is the soul of the body. If you can manage to sleep little, then the master mind will be bright and alert. Not only will your shen qi be flowing freely and purely, but you will also not be disturbed by dreams. Every time you are overcome by a craving for sleep, blood rushes to the heart and the original shen is forced to leave its abode. The clouds then cast a gloomy shadow over the heavenly realm of spirit, and the shen itself will grow dim and unconscious just like its domicile.

The Daoist master Zhang Sanfeng once said: 'Grasp the dream in the dream; behold the darkness within the darkness. Since I saw the face of the girl, I can happily view the paradise, Penglai, right in front of my eyes. This is precisely what I mean! The Neijing , furthermore, states: 'The three months of spring are the period of commencement; heaven and earth are born, and all living things are flourishing. Get up early in the morning, walk around in the courtyard, loosen your hair and relax your body. By doing so you will generate mental strength and act in harmony with the qi of spring, thus following the way of nourishing life. If you live contrary to this principle, you will harm your liver.' Everybody should be aware of this basic principle.

From Cai Luxian, Chinese Medicine and Pharmacology: A Collection (Zhongguo Yiyao Huihai), 1936:

The gallbladder stores the essential fluids. It is thus called the 'chief of staff' and the 'store house of essence.' All the organs are of a murky nature, only the gallbladder is clear. All the other fu organs are called "bowels in charge of transporting" or something like this; only the gallbladder is not labeled as a transporter, but stands out as a 'store house.' It is a fu (transport) network, but has the characteristics of a zang (storage) network.

Blood flow varies according to the time of day, the season of the year, a person's constitution, and the state of physical and mental quietude or agitation. The blood flows at a reduced rate when sleeping, and at an increased rate when physically working. Thirteen centuries ago, the influential Tang dynasty scholar Wang Bing described this function of the liver in the following manner: "The liver stores the blood, and the heart moves it. If a person moves about in a waking state, then the blood is distributed throughout all channels; if a person rests, the blood returns to the liver."

Emotions such as anger, embarrassment, or unexpected joy can also increase blood flow, causing the ears and face to turn red. In situations when less blood is needed, it is "stored in the liver," which thus assumes a warehouse-like function. The actual storage of blood is done in the penetrating vessel, one of the eight extraordinary vessels that extends from the lower dantian to the head; this vessel is often considered to be part of the liver network. The liver is best compared to a managing clerk, who moves goods in and out of the warehouse as they are needed.

Just as important is the liver's function of maintaining a smooth and uninterrupted flow of virtually all body substances (including qi, blood, jing, and liquids and humors). The term shu (sometimes translated as coursing or smoothing) is used to refer to the action of maintaining a mode of operation in the body that is not stagnating, not overly agitated, and continuously flowing. The term xie (sometimes translated as draining) is used to refer to the liver's action of purging stagnation in the spleen/stomach. Proper coursing and draining, or lack thereof, is mostly reflected in the relation of emotions to qi and blood circulation and to the influence of the liver on digestive system functions:

Emotional aspect: the ancient Chinese observed that human emotions are largely governed by the heart network. However, they also concluded that mental well-being or various shades of depression have an association with the coursing and draining function of the liver. Only if the liver carries this task out properly can the body's qi and blood flow unobstructed, and thus facilitate a feeling of ease, harmony, and peace. If for some reason the liver fails to maintain this state, depression (of liver qi) or pathological rising (of liver yang) may result. As the Qing Dynasty classic, A Treatise on Blood Disorders (Xue Zheng Lun), states: "The liver is classified as wood; wood qi is characterized by its determination to go straight to where it wants to go to; if it is not blocked or suppressed, the movement in the vessels will be smooth."

Digestive aspect: since this moving function of the liver regulates the qi flow in the entire body, it influences the dynamics of the other organ networks, particularly the neighboring digestive systems. It assists the upward and downward flows of the spleen/stomach system (the stomach is to move the food mass downward, the spleen is to move the extracted qi upward), passes bile into the intestines, helps to transport food essence, and aids the unobstructed movement and metabolism of water. The Treatise on Blood Disorders says "Coursing and draining is an integral part of liver nature. Once food qi enters the stomach, it is entirely up to the liver wood to course and drain it. Only if this process is intact will grain and water transform properly."

Hun is originally an ancient astronomical term, describing the light of the moon (as opposed to its material body). Just like moonlight is a reflection of sunlight, hun stands for a particular type of consciousness that is reflecting waking consciousness (shen) on another plane. The Neijing comments in its typical terse code: "Hun is that what follows shen going in and out."

Hun can be interpreted as the realm of the subconscious that is particularly active during sleep time. Therefore, all Chinese words that include the character hun describe states of dreaming or trance. As Zhang Jingyue, master physician of the Ming dynasty, put it: "This dim state of consciousness during dreaming, or the elusive visions we see meandering during nocturnal sleep, all fall under the category of hun." Hun, in other words, can be understood as an ethereal type of consciousness which can separate from the body during sleep and interact with other "souls" (as hun is often translated) during this time.

Different from po (see the chapter on lung for more information), the vital instinctive spirit that is tied closely to the material body, hun is what is believed to leave the body after death and what can be called upon in prayers. The wandering ghosts (that usually cause trouble) described in Chinese stories are actually hun that roam about aimlessly, because they have nobody to perform the pacifying sacrificial rites for them.

According to traditional concepts, male physiology is mostly based on qi (yang), while female physiology is primarily based on blood (yin). Males tend to have an abundance of qi that they can afford to spend freely, while females have an abundance of blood that they can give away freely (as becomes evident from the menstrual bleeding). Liver function, therefore, has great influence over an important part of female physiology-menstruation.

The penetrating vessel and the conception vessel, are two pathways linked to the liver that are intimately involved with the transportation of blood. The penetrating vessel, above compared to a warehouse, is also called the Sea of Blood; and the conception vessel, as the name indicates, is credited with the function of nourishing the uterus and the fetus. Both the conception vessel and the penetrating vessel belong to the category of the eight extraordinary vessels. Both these vessels are involved in the liver's ability to store blood; they set out from the uterus, and are also closely linked with the kidney channel.

The Neijing says: "In females, the tiangui (ability to conceive) arrives at the age of two times seven; at this point, the conception vessel will be open, the penetrating vessel will be exuberant, and therefore menstruation arrives in regular intervals and pregnancy becomes possible....At the age of seven times seven, the conception vessel becomes deficient, the penetrating vessel is exhausted, the tiangui dries up, and menstruation stops; aging is taking place and there will be no more pregnancies."

The tendons connect the muscles to the bones. In accordance with the characteristics of the liver, they facilitate smooth and continuous movement. Because of this basic concept, some scholars have recently included the nerves (which do not have a separate designation in classical Chinese theory) under the category "tendons" (jin). The proper functioning of the tendons relies entirely on their nourishment by liver blood.

The nails are considered the surplus of the tendons: as such, they are an exterior manifestation of the general quality of the tendons, and thus, liver blood within. Dry and brittle or extremely pale nail beds always indicate a poor quality of liver blood, while pink nailbeds and firm nails indicate a healthy state of liver blood.

Hair is also associated with the liver blood: it is called the "surplus of the blood" (xue yu). The rich liver blood of females is expressed in lush, long, and fast growing hair on the head; males have more facial and body hair, which is governed by the qi organ, lung. Dry and brittle hair can be an indication of liver blood deficiency, while hair that suddenly falls out (alopecia) is usually because of both deficiency of blood and impeded flow of liver blood to the head, usually due to sudden emotional trauma.

The eyes are nourished by the essence of all five organ networks, and thus differentiated into five organ specific zones which may reveal important diagnostic information. The eyes as a whole, however, represent the opening of the liver, and are thus considered to be more closely linked to the liver than to any of the other organ networks. "Liver qi communicates with the eyes," states the Neijing, "and if the liver functions harmoniously, the eyes can differentiate the five essential colors....If the liver receives blood, we can see. The liver channel branches out to the eyes. Both liver qi and liver blood flood the eyes to maintain proper eyesight. A person's eyesight may therefore also serve as an indicator for liver function.

Just as trees (wood) tend to unrelentingly pursue their upward quest for the light, the liver represents the innate will of the body/mind to spread outward. Just like qi and blood have to spread within the body to ensure physical survival, human shen needs to spread freely through the social environment to guarantee an uninhibited passage through life. Individuals with strong liver qi and blood are usually excellent strategic planners and decision makers: they know how to spread themselves into the world. Due to these qualities, they often make outstanding business managers. If, however, this tough and determined spreading nature of the liver is not in a state of harmonious balance with the softer side of liver wood-ease, smoothness, flexibility-the wood-endangering state of rigidity arises.

The Liver Is Unable to Store the Blood: if the liver fails to be properly nourished by the qi derived from food via the spleen/stomach, or if for some reason the function of storing and regulating the blood becomes affected, symptoms of blurred vision, cramping, inhibited joint movement, dry eyes, night blindness, trembling hands and feet, numb extremities, dry, brittle, malformed, or grey nails, dry and split hair, scanty menstruation, or amenorrhea may occur.

The Liver Loses Its Ability to Course and Drain: if qi gets stuck, the inhibited coursing action of liver qi immediately manifests in the form of mental and emotional symptoms; depression, sensation of emotional pain, or crying are typical examples. If liver qi flares up and upsets the harmonious interplay between body and mind, outbursts of anger, or pain and distention in the sides of the chest may result.

This condition has also immediate consequences to the functioning of the spleen/stomach, specifically the actions of absorbing, transforming, and transporting grain qi (postnatal essence). Typical signs of a liver qi disorder implicating the neighboring spleen/stomach system are belching, regurgitation of stomach acid, vomiting, and diarrhea.

If the liver is not coursing the qi, body fluids (which also rely on liver qi to be moved) may stagnate, with a potential development of edema or ascites. And very importantly, if liver qi stagnates for a long time the proper circulation of blood will be impaired. Therefore, people with chronic diseases that involve liver qi stagnation often present with symptoms of both qi and blood stagnation, such as piercing pain in the chest, tumors and growths, and irregular menstruation.

Liver Disharmony Reflecting on the Emotions and Mental Activities: a deficiency of liver qi typically causes a person to be indecisive and adrift, with a marked inability to plan ahead effectively. If gallbladder qi is deficient, the person will be fearful, have a panicky disposition, and have difficulty making decisions.

Certain emotional states can result from, or cause, liver qi disorders. For example, a state of depression brought on by an unexpected event can eventually cause physical symptoms attributed to liver qi stagnation; liver qi stagnation, in turn, can cause mental depression. An intense outbreak of anger can induce sudden headaches, dizziness, chest pain, and other signs of liver-qi flare up (as the Neijing points out: "When a person is angry, the qi moves up); liver qi flaring up can cause one to feel anger. Sometimes a person will suffer a stroke ("qi and blood rushing to the brain") during or shortly after an outburst of anger. Anger is a physiologically normal emotion and will usually not cause disease. The constant suppression of anger or putting oneself always in a situation that generates anger, on the other hand, can be the cause of long ranging problems, since it promotes a chronic state of internal qi stagnation.

Excess Pathogens in the Liver Channel: wind-heat (external heat) entering the liver channel causes red, swollen, or painful eyes. Upflaring liver fire from internal causes may also produce red eyes, or a white film on the eye. Hyperactivity of liver yang manifests in upwardly mobile symptoms, especially hypertension and dizziness. Liver-wind (internal wind) may produce seizures, uncontrollable eye movements, lock jaw, or tetanic cramping. The Neijing points out that: "All wind and dizziness disorders belong to the liver."

Cold pathogens have a coagulating affect on the liver channel causing abdominal pain radiating to the genitals, testicular pain, or vaginal atrophy.

Course the liver and regulate qi (shu gan li qi): cyperus (xiangfuzi), bupleurum (chaihu), blue citrus (qingpi), curcuma (yujin), melia (chuanlianzi).

Move blood and expel stasis (huo xue xing yu): persica (taoren), carthamus (honghua), tang-kuei (danggui), red peony (chishao), leech (shuizhi), tabanus (mengchong), corydalis (yanhusuo), notoginseng (sanqi), achyranthes (niuxi), leonurus fruit (chongweizi).

Smooth the liver and nourish blood (rou gan): tang-kuei (danggui), peony (baishao), lycium fruit (gouqizi), gelatin (ejiao), zizyphus (suanzaoren).

Moisten the liver and tonify yin (zi yin): rehmannia (dihuang), ho-shou-wu (heshouwu), ligustrum (nuzhenzi), astragalus seed (shawanjili).

Astringe the liver (lian gan): chaenomeles (mugua), mume (wumei), schizandra (wuweizi), peony (baishao).

Clear liver heat (qing gan): scute (huangqin), gardenia (zhizi), prunella (xiakucao), celosia (qingshuangzi).

Purge liver heat (xie gan): gentiana (longdancao), indigo (qingdai), isatis (daqingye), aloe (luhui).

Cool liver blood (liang gan): moutan (mudanpi), lithospermum (zicao), sanguisorba (diyu), biota tops (cebaiye).

Course wind heat in the liver channel (shu feng): chrysanthemum (juhua), mentha (bohe), tribulus (baijili), vitex (manjingzi), siler (fangfeng).

Open the collaterals and sweep out the wind (huo luo sou feng): silkworm (jiangchan), typhonium (baifuzi), scorpion (quanxie), tribulus (baijili), equisetum (muze), agkistrodon (baihuashe), zaocys (wuxiaoshe).

Warm the liver (wen gan): evodia (wuzhuyu), artemisia (aiye), fennel (huixiang), zanthoxylum (chuanjiao), cinnamon twig (guizhi), tang-kuei (danggui).

Calm the liver (ping gan): peony (baishao), uncaria (gouteng).

Sedate the liver (zhen gan): oyster shell (muli), haliotis (shijueming), tortoise shell (guiban), turtle shell (biejia).

Extinguish internal wind (xi feng): gastrodia (tianma), antelope horn (lingyangjiao), centipede (wugong), scorpion (quanxie), silkworm (jiangchan).

If the liver fails to store the blood, it needs to be nourished and smoothed with blood tonic substances such as tang-kuei (danggui) and peony (baishao). If liver yin-the liver's basic physiological substance that gets refined into liver blood-has already been damaged, the liver needs to be moistened with yin tonic substances such as rehmannia (dihuang) or ho-shou-wu (heshouwu).

If liver qi is depressed, the liver needs to be treated with substances that restore its coursing function, such as bupleurum (chaihu) or cyperus (xiangfuzi). If prolonged qi stagnation has affected the blood by causing blood stasis, the liver blood needs to moved and the stasis expelled by using substances like persica (taoren) and carthamus (honghua).

In a situation where an outbreak of rage has triggered a rampant and, usually, upwardly mobile qi flow, the liver needs to be calmed with gently descending substances such as peony (baishao) or uncaria (gouteng). If liver qi surges upwards and draws blood along with it, calming and descending substances need to be combined with herbs that cool liver blood, such as moutan (mudanpi); achyranthes (niuxi) will also guide blood downward. If a fit of anger sets liver fire ablaze, liver heat needs to be cleared with herbs like scute (huangqin), or in more serious situations also be addressed with materials that strongly purge liver heat such as gentiana (longdancao).

If wood fails to course and drain earth, the symptoms of stuckness, fullness, and distress in the middle burner need to be alleviated by coursing the liver (e.g., with bupleurum; chaihu) and harmonizing the spleen/stomach (e.g., with white atractylodes; baizhu).

In the case that wind-heat pathogens have invaded the liver channel network, the wind has to be expelled by using substances that course liver wind, such as mentha (bohe) or chrysanthemum (juhua). If the coagulating influence of cold pathogens are obstructing the proper flow of blood in the liver channels, the liver needs to be warmed and the cold dissipated with herbs like artemisia (aiye) or evodia (wuzhuyu).

If upflaring liver fire causes symptoms of heat in the upper burner, liver heat has to be cleared. If a constitutional yin deficiency causes fire and develops into the serious condition of rebelliously upflaring liver yang, the rampant liver yang needs to be subdued by employing a combination of calming (gently descending) and purging (strongly descending) medicinals. The physician Zhang Xichun, however, has cautioned against pushing down and thereby humiliating the liver-the "proud general" of the organ systems-too intensely; small amounts of substances that promote its physiologically upward qi flow, such as germinated barley (maiya) and melia (chuanlianzi), should be included in formulas that sedate the liver.

If there is liver wind stirring internally, the liver should be calmed and the wind extinguished. If wind-phlegm pathogens block the collaterals causing surface numbness and pain, then substances that can both sweep the wind from the collaterals and clear phlegm obstruction of the collaterals, such as silkworm (jiangchan) or typhonium (baifuzi), should be used.

As an upwardly mobile yang organ, the liver easily suffers from symptoms of hyperactivity. As an emergency measure, the Neijing suggests the ingestion of sweet flavors to moderate symptoms of pain, cramping, and other signs of acute liver aggravation.

Furthermore, as with the wood network that is energetically akin to proliferating spring foliage, the liver has the innate desire to spread and disperse. If this spreading aspect of liver physiology is disturbed, various levels of stagnation manifest and dispersing measures need to be employed. Since pungent flavors can directly disperse stagnation, they can generally be recommended for a condition characterized by stagnant qi. Pungent flavors, however, are generally warming in nature and the liver, particularly when its flow is suppressed, tends to heat up easily. Different from the often exclusive use of pungent substances in lung treatment, it is thus important in liver therapy to include along with the pungent herbs bitter, cold materials. Bitter materials such as scute (huangqin) or gentiana (longdancao) are usually classified as having a heat clearing or heat purging affect. Sour, moreover, is the flavor with a direct affinity to the liver network. If used appropriately, sour foods or herbs can be of benefit to the liver. As the Neijing points out: "Sour generates the liver," but also warns against the excessive use of sour flavors, since this would actually cause damage to the liver system: "If the disease is in the tendon layer, do not eat sour flavors."

Damp heat in the gallbladder needs to be addressed not only by clearing liver heat, but also by disinhibiting gallbladder damp (e.g., with capillaris; yinchen). In situations where gallbladder qi deficiency impacts the smooth circulation of liver qi, general qi tonification needs to be supported by herbs that pacify the shen and nourish kidney yin.

The liver's mother organ and lower burner neighbor, the kidney, when weakened, can have a detrimental affect on the liver's qi, yin, and blood. Thus, liver tonification often indicates the use of herbs like rehmannia (dihuang) and lycium fruit (gouqizi) that also have a tonic affect on the kidney.

LIVER QI STAGNATION (gan qi yu jue): primary symptoms are tendency to get depressed; frequent sighing; impatient disposition and temper outbreaks; sensations of stuffiness; fullness or congestion in the chest, intercostal, or subcostal regions. Secondary symptoms include obstructed bowel movements; dry and distended eyes; feeling of something being stuck in the throat; self-doubts and crying; pain (especially intercostal and abdominal) that is characterized by moving, pulling, or penetrating sensations; in females; premenstrual breast distention; menstrual cramping and irregular menstruation. The tongue typically presents with a reddish body (especially at the sides) and a thin coating; the pulse tends to be wiry.

Representative Herbs: bupleurum (chaihu) with peony (baishao), cyperus (xiangfuzi), curcuma (yujin), cnidium (chuanxiong), blue citrus (qingpi), chih-shih (zhishi), corydalis (yanhusuo), melia (chuanlianzi).

Representative Formulas: Bupleurum and Chih-shih Formula (Sini San); Bupleurum and Cyperus Formula (Chaihu Shugan San).

LIVER BLOOD DEFICIENCY (gan xue xu): primary symptoms are pale face color; dizziness; dry eyes or, at a more advanced stage, blurry vision (especially at night); numbness in the extremities (including arms easily "falling asleep" while sleeping); limited flexibility of tendons and muscles. Secondary symptoms include pale lips and nails; dry, split, atrophied, or malformed nails; muscle twitching; spasms or cramping in the extremities; trembling hands or feet; occasional intercostal pain; ringing in the ears; in females: decreased and pale menstrual flow. The tongue is typically pale or pink; the pulse tends to be fine, or wiry and forceless.

Representative Herbs: tang-kuei (danggui), peony (baishao), gelatin (ejiao), ligustrum (nuzhenzi), cornus (shanzhuyu), cnidium (chuanxiong), zizyphus (suanzaoren), millettia (jixueteng).

Representative Formulas: Tang-kuei Four Combination (Siwu Tang); Tonify the Liver Decoction (Bugan Tang); Linking Decoction (Yiguan Jian) minus melia (chuanlianzi) plus peony (baishao).

LIVER YIN DEFICIENCY (gan yin xu): primary symptoms are dizziness; blurry vision; dry eyes; dull intercostal pain; dry mouth and throat; heat sensations in palms and soles. Secondary symptoms include numbness in extremities; limited tendon flexibility; lusterless nails; impatient disposition and temper outbreaks; flushed cheeks; dark urination; constipation; low grade fever; restlessness and insomnia; tidal heat sensations; night sweats. The tongue typically presents with redness and little or no coating; the pulse tends to be wiry and fine, or wiry, fine, and rapid.

Representative Herbs: peony (baishao), lycium fruit (gouqizi), ligustrum (nuzhenzi), gelatin (ejiao), tang-kuei (danggui), rehmannia (dihuang), cornus (shanzhuyu), ho-shou-wu (heshouwu), turtle shell (biejia), zizyphus (suanzaoren), biota (baiziren).

Representative Formulas: Linking Decoction (Yiguan Jian); Ligustrum and Eclipta Formula (Erzhi Wan).

LIVER FIRE BLAZING (gan huo shang yan): primary symptoms are pain and distention in the head; dizziness; ringing in the ears or sudden deafness; red face; red, swollen, or painful eyes; dry and bitter sensation in the mouth; marked impatience and tendency to throw fits of anger. Secondary symptoms include insomnia; vivid dreaming; throbbing or burning pain along sides of chest; dark urination; constipation. The tongue typically presents with a red body and a yellow coating; the pulse tends to be wiry and rapid.

Representative Herbs: gentiana (longdancao), prunella (xiakucao), gardenia (zhizi), chrysanthemum (juhua), aloe (luhui), antelope horn (lingyangjiao), bupleurum (chaihu), ch'ing-hao (qinghao), moutan (mudanpi), eriocaulum (gujingcao), celosia (qingxiangzi).

Representative Formulas: Gentiana Combination (Longdan Xiegan Tang); Tang-kuei and Aloe Pill (Danggui Luhui Wan); Purge the Green Pill (Xieqing Wan).

REBELLIOUS UPFLARING OF LIVER YANG (gan yang shang kang): primary symptoms are dizziness; distention and pain in the head; ringing in the ears; redness and heat sensation in the face and upper part of the body. Secondary symptoms include insomnia; vivid dreaming; impatience; angry disposition; heavy head and "light feet" (easily stumbles); weak and sore lower back and knees; dry mouth and throat. The tongue is typically red; the pulse tends to be wiry and forceful, or wiry, fine, and rapid.

Representative Herbs: uncaria (gouteng), haliotis (shijueming), dragon bone (longgu), oyster shell (muli), gastrodia (tianma), tribulus (baijili), silkworm (jiangchan), peony (baishao), tortoise shell (guiban), turtle shell (biejia), rehmannia (dihuang).

Representative Formula: Gastrodia and Uncaria Combination (Tianma Gouteng Yin).

LIVER WIND STIRRING INTERNALLY (gan feng nei dong): primary symptoms are cramping; seizures; trembling; shaking; dizziness; and numbness. This category is usually divided into three subcategories:

Extreme Heat Generating Wind (re ji sheng feng): primary symptoms are high fever, restlessness, thirst, flushed face, red eyes, seizures or cramping. Secondary symptoms include dark urination; constipation; upwardly turned eyes; unconsciousness; delirious talk. The tongue typically presents with a red body and a yellow coating; the pulse tends to be wiry and rapid.
Representative Herbs: rhino horn (xijiao), antelope horn (lingyangjiao), ox gallstone (niuhuang), uncaria (gouteng), gastrodia (tianma), anemarrhena (zhimu), raw rehmannia (sheng dihuang), chrysanthemum (juhua), scute (huangqin).
Representative Formulas: Antelope and Uncaria Decoction (Lingyang Gouteng Tang ); Ox Gallstone Pacify the Palace Pill; Bezoar and Curcuma Formula (Angong Niuhuang Wan).
Hyperactive Liver Yang Producing Wind (gan yang hua feng): primary symptoms are cramping; seizures; numbness in the extremities; paralysis (especially of the hemiplegic type); slurred speech; mouth and eyes going off to one side. Secondary symptoms include sudden loss of consciousness or severely impacted mental faculties; splitting headache; severe dizziness; weakness or soreness in lower back and knees; dry mouth; flushed face. The tongue is typically bright red; the pulse tends to be wiry.
Representative Herbs: uncaria (gouteng), gastrodia (tianma), achyranthes (niuxi), hematite (daizheshi), silkworm (jiangchan), cicada (chantui), centipede (wugong), peony (baishao), rhino horn (xijiao), ox gallstone (niuhuang), antelope horn (lingyangjiao).
Representative Formulas: Sedate the Liver and Extinguish the Wind Decoction (Zhengan Xifeng Tang); Downward Momentum Decoction (Jianling Tang).
Blood Deficiency Generating Wind (xue xu sheng feng): primary symptoms are dizziness; headache; blurry vision; numbness in the extremities or, in more severe cases, symptoms of cramping, trembling, or twitching. Secondary symptoms include dry and itching skin; fainting spells; and general blood deficiency symptoms such as pale complexion, pale lips and nails, brittle or malformed nails, and dull intercostal pain. The tongue typically presents with a pale body and little coating; the pulse tends to be fine and wiry.
Representative Herbs: cooked rehmannia (shu dihuang), peony (baishao), tang-kuei (danggui), millettia (jixueteng), earthworm (dilong), uncaria (gouteng).
Representative Formulas: Tang-kuei Four Combination (Siwu Tang); Settle Tremor Pill (Dingzhen Wan).

COLD PATHOGENS HAVING A COAGULATING AFFECT ON THE PROPER FLOW IN THE LIVER CHANNELS (han chi gan mai): primary symptoms are lower abdominal distention and pain. In females, these may include symptoms of menstrual cramping or pain due to abdominal masses; in males, radiating pain to or from the testicles, or general aversion to cold and preference for warm temperatures are indications. Secondary symptoms include testicular cold sensation or undescended testicle; atrophy of scrotum; cold extremities; little desire to drink fluids; clear and profuse amounts of urination. The tongue is typically moist and presents with a slippery white coating; the pulse tends to be deep and slow, or deep and wiry.

Representative Herbs: tang-kuei (danggui), cinnamon twig (guizhi), evodia (wuzhuyu), artemisia (aiye), lindera (wuyao), fennel (huixiang).

Representative Formulas: Tang-kuei, Evodia, and Ginger Combination (Danggui Sini Jia Wuzhuyu Shengjiang Tang); Warm the Liver Decoction (Nuangan Jian); Tiantai Mountain Lindera Powder (Tiantai Wuyao San); Fennel and Citrus Seed Pill (Huixiang Juhe Wan).

DAMP HEAT IN THE LIVER/GALLBLADDER (gan dan shi re): primary symptoms are discomfort, stuffiness, or pain in chest, epigastric, or subcostal region; abdominal distention; nausea; bitter or unpleasant taste in mouth; no appetite; restlessness; easily angered; dark urination. Secondary symptoms include alternating heat/cold sensations; thick and colored vaginal discharge; itching or swollen genitalia; obstructed bowel movements; jaundice and yellow eyes. The tongue typically presents with a reddish body and a greasy yellow coating; the pulse tends to be wiry and rapid.

Representative Herbs: gentiana (longdancao), capillaris (yinchen), gardenia (zhizi), scute (huangqin), rhubarb (dahuang), indigo (qingdai), akebia (mutong), alisma (zexie), plantago leaves (cheqiancao), hoelen (fuling), coix (yiyiren), talc (huashi), bupleurum (chaihu), curcuma (yujin).

Representative Formulas: Bupleurum and Chih-shih Formula (Sini San) plus capillaris (yinchenhao); Gentiana Combination (Longdan Xiegan Tang); Capillaris Combination (Yinchenhao Tang).



From the Daoist classic, Contemplations by the Huainan Masters (Huainanzi) , ca. 110 B.C.:

The heart is the ruler of the five organ networks. It commands the movements of the four extremities, it circulates the qi and the blood, it roams the realms of the material and the immaterial, and it is in tune with the gateways of every action. Therefore, coveting to govern the flow of energy on earth without possessing a heart would be like aspiring to tune gongs and drums without ears, or like trying to read a piece of fancy literature without eyes.

From the Daoist classic, Guanzi, prior to 200 B.C.:

The heart is the emperor of the human body. Its subordinate officers are in charge of the nine orifices and their related functions. As long as the heart remains on its rightful path, the nine orifices will follow along and function properly. If the heart's desires become abundant, however, the eyes will lose their sense of color, and the ears will lose their sense of sound. Thus it is said: 'Keep your heart empty-this is the art of the heart through which the orifices can be mastered.'

Deviation above will necessarily cause malfunction below. Do not race your heart like a horse, or you will exhaust its energy. Do not fly your heart like a bird, or you will injure its wings. Never frantically move things around just for the sake of seeing what will happen. If you move things around you dislocate them from their proper place. If you will be calm and patient, everything will come to you by itself.

The Dao is never far away, yet it may be hard to reach. It is within every one of us, yet it may be hard to grasp. If we stay clear of desires, the shen will enter its home. If we sweep away all impurities, the shen will stay with us. Human beings all crave intelligence and wisdom, but rarely do we try to understand what the source of their existence is. Alas, intelligence, intelligence-even if you jump over the ocean, it will not just sit there waiting for you! The seeker will be limping behind the one who is without desires. The sage does not seek anything, and thus naturally achieves the state of vacuous understanding [ultimate knowledge apart from fixed concepts].

From Li Ting, A Primer of Medicine (Yixue Rumen) , 1575:

The heart is the master of the body and the emperor of the organ networks. There is the structural heart made from blood and flesh: it has the shape of a closed lotus flower and is situated underneath the lung and above the liver. And there is the luminous heart of spirit-shen-which generates qi and blood and thus is the root of life. It is the source of all our bodily parts and functions, yet it does not manifest in obvious signs and colors. Just when you want to define it and say 'here it is,' it is gone; whenever you forget about it, however, it comes closer to you than ever. This is why it is called the 'vacuous spirit.' Despite its elusive nature, shen commands our body's every action and every part. Material form and luminous shen must therefore be looked upon as an interdependent pair, and we have to understand that diseases of the structural heart are always caused by unbalanced emotions such as depression, anxiety, obsession, or sadness, which open up a pathway through which noxious pathogens can enter.

From Li Yuheng, Unfolding the Mat with Enlightening Words (Tuipeng Wuyu) , Ming dynasty, 1570:

The ancient book of definitions [Neijing] refers to the heart as the ruler of the human body, the seat of consciousness and intelligence. If we decide to nourish this crucial element in our daily practice, then our lives will be long, healthy, and secure. If the ruler's vision becomes distracted and unclear, however, the path will become congested, and severe harm to the material body will result. If we lead lives that are centered around distracting thoughts and activities, harmful consequences will result.

The sage regards his/her body like a country: the heart is the ruler, and the jing and the qi are the citizens. If the heart does not abuse its superior position, if it remains centered and focused on the essential matters, the jing will flourish and the qi will be steady, noxious intruders will always be fought off, the dantian will be full with treasures, and every part of the body landscape will be light and at piece.

From Shen Jin'ao, Dr. Shen's Compendium of Honoring Life (Shen Shi Zunsheng Shu) , 1773:

All of the twelve channel networks obey the orders of the heart. The heart, therefore, is the ruler of the organ networks. Its position is south, its season is summer, and its nature is fire. The heart thus represents the principle that is referred to as the body's imperial fire (jun huo). Its relationship to the other organs is hierarchical; not only do the twelve channel networks attune their respective qi [functions] to the directives of the heart, but they offer their entire jing [material essences] as tribute to nourish the heart.

The heart, therefore, is the root of life, the seat of shen, the master of blood, and the commander of the vessels. This elevated position is due to the omnipresence of shen: shen resides within qi, and qi resides within jing. Only the heart's jing is always abundant, enabling it to dispatch subordinate shens to the other four zang organs. Only the heart's qi is always abundant, enabling it to draw the jing of the body into the six fu organs. These are the major functions of the heart.

The heart is connected to the kidney. The classic [Neijing] states: 'The heart resides in the vessels. It rules the kidney network, not via a controlling position in the restraining circle of relationship between the organ networks [where the kidney actually restrains the heart], but simply because it is the general master of all organ networks. Before the heart fire can harmoniously blend with the kidney water, however, the kidney water must be sufficient. Otherwise the heart fire will flare out of control, and all kinds of heart and kidney ailments will arise.'

Due to this interdependent relationship between the heart and the kidney, there are two methods of nourishing and protecting the heart: First of all, there is the method of nourishing the heart qi directly, that is, via its own channel network. This means: do not burden yourself with depressing thoughts, do not get anxious about future events that may never happen, do not dwell on things that are well in the past-all of these emotions dissipate the brightness of shen. If we overextend our heart we will harm its qi. If this happens, the heart jing will also suffer damage, and the shen, consequently, will lose its abode. If we take a look at the doctrines of Confucius-do not will, do not strive, do not be inflexible, do not be egotistical-and his student Mencius-do not be self-righteous, do not expect things, do not force things-we see that the art of nourishing the heart had already been fully understood during the ancient times of Confucius and Mencius. Even though both masters never said much about medicine, they certainly understood how to nourish the heart.

Secondly, there is the option to foster the heart by nourishing its jing via the kidney network. This means: moderate your sex life and do not lust after women, otherwise your ministerial fire (xiang huo) will flare up and become unstable. If there is no protective maintenance of the kidney, the kidney jing will be harmed. If the kidney jing is harmed, then its qi will also suffer detrimental influences. Water, then, will be unable to restrain fire, yin will be unable to provide shelter to yang, and pathological water qi will enshroud the heart.

This is precisely what Master Xiangchuan meant when he said: 'Jing can generate qi, and qi can generate shen; there is nothing greater than a healthy body brimming with ying [jing] and wei [qi]! A practitioner seeking to nourish life must first of all treasure his jing. If the jing is plentiful, there will be abundant qi; if qi is abundant, there will be abundant shen; and if shen is abundant, the body will be strong. Finally, if the body is strong, there will be no disease.' The master physician Zhu Danxi (1282-1358), moreover, wrote once: 'The kidney is in charge of bracing and storing, the liver is in charge of harmonizing the flow. Both organ systems contain ministerial fire, and at their upper end they are linked to the heart. The heart emperor represents fire-once aroused, it flares up. If the heart's imperial fire flares up, the ministerial fire will also flare and the jing will naturally wander astray. This shows us that jing is braced by the kidney and activated by the liver, and that leakage of jing is usually initiated by the heart. If one of these networks loses its equilibrium, the other parts will be affected, too.' What Xiangchuan and Danxi express so lucidly here represents the collective warning that the ancient masters of heart nourishment have issued since times immemorial. In sum, if the heart is not properly nourished, it will fall ill; if the kidney is not properly nourished, the heart will also fall ill.

The heart, moreover, is said to be in charge of blood; and blood is jing. Under normal circumstances there is a natural surplus of heart qi, but in the event that jing is harmed and blood is lost, the heart will become deficient. If blood is plentiful, therefore, our shen will be bright, but if the blood becomes exhausted our will power will become weak and muddled. Any situation of excess fire in the body involves a deficiency of blood; and blood deficiency, in turn, diminishes the beneficial functions of fire.

Is it then that these internal excess and deficiency conditions of the heart bear similarities to external imbalances such as fire stagnation or fire pathogens that saturate the atmosphere during certain times of the sixty year cycle of cosmic circulation? Indeed, both external and internal imbalances of this nature have to be counteracted by restraining one's jing to sustain the qi, and by nourishing one's yin to solidify the shen.

The term "shen," frequently translated today as "spirit," encompasses some of the most complex concepts of traditional Chinese medicine. In the Neijing, shen is mentioned about 240 times. Traditionally, the term refers to the mechanism of change, the mystery of sudden and profound transformation, and the expression in a person's face, particularly the eyes. When applied to the human body, the term describes a major part of what would be called physical vitality, mental activity, and spirit.

Three main functions are attributed to shen:

mental activity (consciousness) as a manifestation of the central, albeit hidden, movement of shen. The ancient character shows a close affinity to the Big Dipper, which the Chinese viewed as the center of the universe. Shen, therefore, appears to be at the heart of all mental and physical activities, just as the Dipper appears to be the central pivot of the stars. As the Neijing puts it: "The heart is the emperor of the five zang and the six fu networks...; if the heart flares, then all of them will get out of line." The heart, via the flame of shen that it harbors within, is therefore like a lantern in charge of illuminating the outside world; it is seen as the source of thought processes. Any thought or idea, the will to carry it out, mental focus, planning, and intelligence can thus be considered to be manifestations of shen;
the seven emotional reactions (joy, anger, sadness, grief, fright, apprehension, worry) and their involuntary expressions (facial expressions, body movements, gestures, sighing, moaning, giggling, sobbing) are manifestations of shen; and
the controlling and regulating effect of the heart over mental and physical properties that are classified as the five modes of operation (wushen): hun, po, yi, zhi, and shen (this latter being the same term). Each of the modes is attributed to one of the five organ networks:
hun refers to the self-awareness and self-control mechanism; associated with the liver;
po refers to the body's basic reactive instincts associated; with the lung;
yi refers to the ability of thinking and remembering; associated with the spleen;
zhi refers to the function of memory; associated with the kidney;
shen refers to the function of processing all incoming sensory and intuitive information and supervising the body/mind reaction to it; associated with the heart.
When trying to comprehend the central aspects of Chinese medicine, it is extremely important to understand the dominant effect of the "immaterial shen" over the physical structure of the body. "If shen is strong," one of the Neijing's classic definitions reads, "the body will be strong; if we lose shen, the body will perish." Just like the Dipper in the sky appears to regulate the movement of sun (yang) and moon (yin), shen commands the basic movement of bodily yin (blood) and yang (qi).

It can be said that shen operates beyond the realm of physical form; it always relies, however, on the continuous supply of the more dense and less refined qi and jing which constitute the material foundation of the body. The inter-relationship is as follows: the workings of shen rely on both pre- and postnatal jing-qi, while the movement and transformation of physical jing and qi, in turn, are controlled by shen.

Blood is a type of "jing"-the latter being a term that always refers to sticky refined body substances which comprise the fundamental yin essence of the body (bone marrow, sperm, vaginal fluids, blood, saliva, etc.). Blood is regarded as a particularly important element of the material basis for shen activity. Further, the blood vessels are an important extension of the heart. In Neijing terms: "The heart network includes the blood vessels, and the blood vessels house shen." Extensive blood loss has a devastating affect: the afflicted person will be without shen-unconscious.

As long as the heart is in motion, blood circulates through the vessels; and as long as this is the case, a person is alive. The blood vessels constitute one of the structural aspects of the heart network. From an evolutionary point of view, the physical heart is actually a local elaboration of the blood vessels. In a human embryo, it is a network of primitive blood vessels that appears first. Only later are parts of this network modified to form the physical heart.

From a Chinese perspective, blood is primarily produced in the process of extracting food essence in the middle burner. The definitive section in the Neijing states:

The middle burner is located underneath the upper burner and is closely associated with the stomach. It is in charge of extracting qi from food, of discarding the dregs, of assimilating the vital fluids, of transforming them into the body's own jing, and then transporting this final product up to the lung and eventually transforming it into blood which nourishes the entire body; there is no substance within the body that is more precious than this.

In other words, fluids and nutritive qi derived from food enter the blood vessels where they are further transformed and refined. This process is usually referred to as "turning [the fluids into] red [blood]." Other organs involved in the process of manufacturing blood are the kidney (transforms jing into blood) and the spleen/stomach (produce food essence). The liver regulates blood flow and blood storage (amount retained in the body) and is considered to be the other major blood organ. The heart circulates the blood.

Blood moves through the body in an open-ended circle, providing the material basis for all aspects of mental activity and all organ networks and their associated body layers (skin, muscles, tendons, and bones). In the original terms of the Neijing : "If the liver is supplied with blood, we can see; if the feet are supplied with blood, we can walk; if the hands are supplied with blood, we can grasp." The pumping action behind this central cycle of life giving movement is governed by the heart.

If the quality of heart blood is unblemished, the myriad of fine vessels in the face will be well supplied, and the person will present with a rosy and lustrous complexion. Chinese medicine, therefore, has traditionally regarded the face as a mirror of the condition of the heart. Again, the Neijing points out: "If the qi of the shaoyin hand (heart) network becomes obstructed, the blood vessels will cease to function. If the vessels cease to function, the blood will not move. If the blood does not move, the skin and body hair will lack nourishment. Thus the face will turn grey like lacquer and the blood will perish."

The essential "looking" aspect of the four-fold system of Chinese diagnosis refers primarily to the observation of the face. Since the conditions of both blood and shen reflect here, the face can tell much about the general state of a person's physical and emotional state. The Neijing's "superior doctor"-also called shen (different character)-thus knows about the condition of a patient by looking at the face alone.

In general, it can be said that the occurrence of sweat is controlled by the opening of pores that are managed by the body's protective qi (wei qi). Sweat production, however, relies on the process of distilling pale fluid from the blood by "steaming" transformation. As is observed in the Neijing: "A person who has lost large quantities of blood does not sweat anymore, and the one that has lost large quantities of sweat does not have any blood anymore."

Comprising a transformed blood material, sweat is therefore considered to be quite a precious substance in the Chinese tradition, while it is generally ignored, or simply considered a bothersome part of life, in the Western cultures. Oriental physicians usually shake their heads when told about Western health rituals that entail the frequent and deliberate secretion of sweat, such as weekly saunas or intense daily exercise schedules. On the other hand, it could be argued that people living in industrial societies tend to have a much richer diet than those living in traditional rural societies; for them, failing to sweat enough could lead to accumulation.

The organs, classified as zang and fu, are paired. While the zang organ serves as a residence (the shen resides in the heart) and a major transporter (the heart moves the blood) the fu organ serves only as a transfer station, temporarily storing material that is to be discharged. The heart is paired with the small intestine, interconnected by the luo vessels. The small intestine receives partially digested food residue from the stomach and proceeds with the process of digestion by separating it into "pure" and "impure" substances, thus providing its transfer functions. Pure essence is being recirculated to the spleen, which is in charge of transporting it to the five organ networks where it can be stored. Fluids reabsorbed from the dregs are being passed on to the bladder, which stores and expels surplus liquid from the body. Solid waste matter is transmitted to and expelled via the large intestine.

Some cases of burning urination (particularly if accompanied by symptoms of dark or red urine) are treated by clearing heat in the heart: this heat, transferred from zang to fu (heart to small intestine) is then carried to the bladder with the fluid wastes.

An internal branch of the heart channel connects with the tongue. The Neijing states: "The heart qi communicates with the tongue. If the heart is in a state of harmony, the tongue can distinguish the five essential flavors."

The color of the tongue body reflects the condition of heart blood. A deep red or scarlet tongue, for instance, usually indicates the presence of toxic heat in the blood. At a severe stage, toxic heat may adversely affect shen and eventually cause loss of consciousness (as in the case of encephalitis or other febrile diseases). A pale tongue usually indicates blood deficiency.

Just as important in the context of heart-tongue relation is the second meaning of the Chinese term "xin" (heart), namely, center. In Chinese medical terminology, "xin" often refers to or at least implicates the stomach, since the epigastric region constitutes the structural center of the torso. We know that diseases of the structural heart often manifest as symptoms of stomach pain. Vice versa, stomach problems, such as ulcers, can both cause and be exacerbated by mental symptoms that in Chinese terms would be classified as a heart disorder. In clinical diagnosis, the physical tongue body serves as an indicator of the condition of the organs (especially the circulation through the organs), while the tongue coating serves as an indicator of the situation of the digestive system. Clinicians primarily seek information about the heart's condition from the tip of the tongue where imbalances of the upper burner organs, lung and heart, may reflect.

The pericardium or "heart protector" is said to be a shielding layer enveloping the heart. Just as an emperor is surrounded by a dense circle of intermediaries, the pericardium forms a network of finely meshed pathways around the heart through which both the heart's qi and blood have to pass on their way to and from the far reaches of the body landscape. The pericardium is categorized as a separate organ, yet, as the heart's last line of defense against invading pathogens, it clearly is an integral part of the extended heart network. The Neijing emphasizes: "If we talk about pathogens [evil] entering the heart, we always mean that the pathogens have advanced to the pericardium." If pathogens would indeed advance to the actual innermost, where all mental and physical functions are conceived and coordinated, the result would be like that of foreign rebels advancing to the throne room of the imperial palace: demise of the country results.

Obstruction of the Heart Orifice: At an advanced stage of pathology, heat pathogens may obstruct the pericardium and thus cause the orifice to the heart-the crucial opening through which the flame of consciousness illuminates the outside world-to become blocked. Typical symptoms are unrelenting high fever, loss of consciousness, and delirious talk. If the orifice of the heart becomes obscured by phlegm fire, epileptic seizures or outbreaks of madness may occur. It is important to note that the term "obstructed heart orifice" is not a label for common emotional disorders, but indicates an acute situation where all mental faculties are seriously impeded.

Lack of Nourishment to the Heart Shen: If heart yin, that is the basic material substance of the heart (heart blood), is deficient, a person's shen will become deprived of the nourishment it requires and will be unable to rest. Symptoms of insomnia, confusion, memory loss, and other mental symptoms are possible results of this condition.

Obstruction by Phlegm-Rheum: If the heart yang, the flame of life, is deficient, water accumulates in the upper part of the torso and gives rise to a frequently occurring symptom complex that is referred to as "water qi intimidating the heart" (shui qi ling xin). Palpitations, edema, asthmatic breathing, pulmonary heart disease, and related conditions are typical manifestations of this situation.

Frenetic Blood Movement Due to Blood Heat: Exuberant heat in the internal "blood layer" can cause the blood to deviate from its proper course in the vessels, resulting in various kinds of hemorrhaging. If the yang vessels are harmed, bleeding occurs in the upper part of the body (nosebleed, vomiting of blood, expectoration of blood); if the yin vessels are harmed, bleeding occurs in the lower part of the body (blood in stool, urine, metrorrhagia). This type of pathology (heat, hyperactivity, affecting the blood) is also associated with the other blood network: the liver.

Blood Stasis: If blood stasis occurs in the vessels for prolonged periods of time, pathological or "dead" blood will form and severely impact both mental and physical aspects of the heart network. Prolonged or recurrent bleeding is also a major cause of blood stasis, which in turn may bring about further hemorrhaging. Blood stasis is also associated with the other blood network, namely the liver: inhibited flow of liver qi is most often responsible for blood stasis.

Blood stasis in the pericardium is a common cause of angina pectoris. Ancient texts frequently describe a heart attack (sudden chest pain, loss of voice, lips and face turn blue, hands and feet turn cold and blue) as a syndrome of "polluted blood attacking the heart."

Heart Heat Manifesting in the Small Intestine: Imbalances of zang organs frequently manifest as symptoms in their associated fu network. Thus, heart heat may manifest as burning diarrhea with intestinal cramping or burning urination (often with dark or red urine) that represents transfer of heat from small intestine to bladder. Conversely, small intestine heat can result in heart symptoms such as restlessness or mouth ulcers.

Heart Disorder Affecting the Tongue: Deficiency of heart blood usually causes the tongue to take on a pale color. Mouth ulcers frequently arise from heart or small intestine heat. Stasis of heart blood often reflects in the form of purple spots in the tongue body or in the discoloration/malformation of the veins underneath the tongue. If heat toxins have invaded the pericardium, or if phlegm obscures the orifice to the heart, patients may lose control over their tongue. Stroke victims, for instance, often experience stiffness of the tongue resulting in the common post-stroke phenomenon of slurred speech.

Deficiency of Heart Yin (Blood): Besides the mental symptoms indicating a malnourished shen, there may be physical symptoms such as palpitations, dizziness, a pale face, dry skin and body hair, and a fine, weak, and often rapid pulse. Since the liver network is in charge of storing the blood, blood deficiency most commonly involves the liver.

Excessive Joy Injuring the Heart: Under normal circumstances, joy can relieve tension, stimulate the flow of qi and blood, and harmonize the (nutritive) ying and (protective) wei layers. If this particular emotion is exaggerated, however, the qi will disperse and shen will scatter. Intense and prolonged emphasis on joy, in other words, can impair a person's focus and concentration. A person who has been giggling/laughing for a long time and now has a hard time stopping and regaining control, is, at least during this particular moment, without shen (that is unable to focus). In cases where the shen becomes so severely dispersed that it cannot find its way back to its physical "home," madness may result. Shock causes the heart shen to become dispersed and all subordinated shen to deteriorate into a state of disarray. Typical manifestations of this problem are loss of consciousness, epilepsy, or dementia that have been induced by a shock (a frightful experience). Vice versa, a deficiency of heart qi can cause a person to be easily startled.

Nourish blood (bu xue): tang-kuei (danggui), salvia (danshen), rehmannia (dihuang), millettia (jixueteng).

Nourish the heart and pacify shen (yang xin an shen yang ): fushen (fushen), zizyphus (suanzaoren), biota (baiziren), succinum (hupo).

Tonify qi (bu xin yi qi): ginseng (renshen), polygala (yuanzhi), longan (longyanrou), baked licorice (zhi gancao).

Warm yang (wen yang yi qi): cinnamon bark (rougui), cinnamon twig (guizhi), aconite (fuzi), alpinia (yizhiren), (zishiying).

Astringe and tonify yin (lian yin): schizandra (wuweizi), cornus (shanzhuyu), peony (baishao), mume (wumei).

Purge fire (xie huo): coptis (huanglian), gardenia (zhizi).

Clear heart heat (qing xin): rhino horn (xijiao) or water buffalo horn (shuiniujiao), forsythia (lianqiao), and the "heart" portions of bamboo leaves (zhuye) and lotus (lianzi xin; lotus embryo).

Sedate the heart and settle shen (zhen xin an shen): cinnabar (zhusha), dragon bone (longgu), oyster shell (muli), magnetite (cishi), rust (sheng tieluo).

Open the orifice of the heart (kai qiao): borneol (bingpian), musk (shexiang), acorus (shichangpu), styrax (suhexiang).

Open the orifice by dispelling heat phlegm (huo tan): bamboo sap (zhuli), ox gallstone (niuhuang), bamboo resin (tianzhuhuang), bile treated arisaema (dan nanxing), fritillaria (beimu), pinellia (banxia).

Transform water rheum to calm the heart (hua yin ning xin): hoelen (fuling), atractylodes (baizhu), cinnamon twig (guizhi), akebia (mutong).

Move the blood (huo xue): persica (taoren), carthamus (honghua), cnidium (chuanxiong), achyranthes (niuxi).

Drive out blood stasis (zhu yu): leech (shuizhi), tabanus (mengchong), eupolyphaga (tubiechong), pteropus (wulingzhi).

Soften and dissipate masses (ruan jian): zedoaria (ezhu), sparganium (sanleng), anteater scales (chuanshanjia), turtle shell (biejia).

Stop bleeding (zhi xue): notoginseng (sanqi), bulrush (puhuang), bletilla (baiji), sanguisorba (diyu), cephanoplos (xiaoji), lotus nodes (oujie).

Cool the blood: red peony (chishao), raw rehmannia (sheng dihuang), moutan (mudanpi), lithospermum (zicao).

Although many blood disorders are treated via the liver, it is the heart that is officially considered to be the master of the vessels and their content. Blood disorders, therefore, are often associated with the heart. If blood heat causes eruptions or bleeding, the blood needs to be cooled. If blood cold causes stagnation and pain, the channels need to be warmed. In cases of bleeding, additional hemostatic measures can be applied, but it is imperative to first clearly differentiate the cause for the condition; blood heat, spleen qi deficiency, and blood stasis can all be potential causes.

Since the heart stores the shen, the label "heart disorder" often stands for situations where the shen cannot be properly stored. This primarily manifests in symptoms of mental agitation, such as insomnia, vivid dreaming, irritability, or hysteria. If the shen is agitated due to the presence of excess pathogens, the removal of the pathogens (heat, phlegm, stagnant blood) is often sufficient to settle an agitated shen. Often, however, it is a deficiency of heart blood-the material (yin) pool that keeps the volatile (yang) shen grounded-which is at the root of this condition. In this case, the blood must be nourished to restore the material basis of shen and give it a residence that it feels enticed to return to. To achieve a more immediate effect, it is advisable in both cases to include herbs that have a sedative action on the heart and thus directly settle the shen. Usually, substances with a settling affect are heavy in nature, such as cinnabar (zhusha), magnetite (cishi), oyster shell (muli), or dragon bone (longgu). A subdued heart can also cause a dispersal of shen focus, and a slow beating pulse can cause the blood to stagnate in the vessels; in such cases, it is necessary to invigorate the heart and vitalize the blood circulation.

Just like a bright fire burns pure and is not obscured by smoke, the heart and its light of consciousness remain pure unless pathogenic influences, such as impure qi or phlegm, block the heart orifice. If impure qi veils the flame of consciousness, herbs that expel impurity and open the orifice should be used. If blood stasis clogs the heart collaterals (vessels), then measures that drive out stasis and unblock the collaterals should be employed.

If the material basis of the heart, the heart yin and heart blood, are deficient, nourishing of yin and/or blood is indicated. If the force of the heart-the heart yang and heart qi-are deficient, yang should be warmed and qi should be tonified. In case that a heart yang deficiency has already caused pathological water and phlegm to accumulate, measures that support heart yang need to be accompanied by herbs that drive out water rheum and phlegm.

In case there are obvious signs of dispersed heart qi (palpitations, shortness of breath), deficient heart yin (sweating), or disturbed heart shen (inability to concentrate), sour flavors can be used to astringe the various substances of the heart. The famous turn of the century physician Zhang Xichun, for instance, often decocted large amounts of the sour fruit cornus (shanzhuyu) and gave it to patients in emergency situations to keep their shen qi from leaving the body. Most commonly, today, schizandra is used to astringe both heart yin and heart qi.

Bitter is the flavor with a direct affinity to the heart network, and thus should be used, but sparingly, in patients with heart problems. Bitter flavors have a drying effect, and, when used in large amounts, can have a potentially damaging affect on heart yin.

In a situation where the heart has transferred pathological heat to the small intestine, treatment should clear heart heat, descend fire, and guide out the heat via the lower burner.

In the treatment of all heart disorders, the network's relationship to other systems needs to be taken into consideration. In deficiency situations, for instance, the "tonify the mother" rule applies; heart yin/blood deficiencies are thus primarily addressed by tonifying the liver yin/blood. Also of particular importance is the heart's relationship to its upper burner neighbor, the lung. Since the heart is the lung's controlling organ, heart pathology occasionally manifests in bloody (heart colored) phlegm. On the other hand, prolonged phlegm accumulation in the lung will eventually affect the heart, causing palpitations, chest pain, and pulmonary heart disease. In this situation, it is primarily the pathological water in the lung that needs to be addressed. Furthermore, the heart forms the shaoyin network along with the kidney. Since the heart is above and the kidney below, it is one of the critical physiological tasks to connect and mingle the energies of the heart and the kidney despite the natural tendency of water to flow down and fire to flare up. If the body's polar water and fire networks fail to link up properly, symptoms of restlessness, insomnia, and other signs of the water organ failing to control the fire organ occur. In this case, the heart and the kidney need to be "reconnected" by clearing heart fire (descending heart fire) and steaming kidney water (ascending kidney water); an example is using a small amount of bitter coptis to reduce the heart fire with a small amount of hot spicy cinnamon to steam the kidney water.

HEART BLOOD DEFICIENCY (xin xue xu): primary symptoms are palpitations; pale and lusterless complexion. Secondary symptoms include insomnia; vivid dreaming; forgetfulness; tendency to easily get startled; dizziness; pale lips and nails. The tongue is typically pale; the pulse tends to be fine.

Representative Herbs: tang-kuei (danggui), cooked rehmannia (shu dihuang), salvia (danshen), peony (baishao), gelatin (ejiao), longan (longyanrou), zizyphus (suanzaoren), biota (baiziren), fushen (fushen), millettia (jixueteng).

Representative Formula: Tang-kuei Four Combination (Siwu Tang).

HEART YIN DEFICIENCY (xin yin xu): primary symptoms are palpitations; panic sensations; insomnia; vivid dreaming; dry mouth and throat; heat sensation in palms and soles. Secondary symptoms include forgetfulness; restlessness; tendency to easily get startled; flushed cheeks; dark urination; dry stools; tidal heat sensations; night sweats. The tongue is typically red with little coating; the pulse tends to be fine and rapid.

Representative Herbs: raw rehmannia (sheng dihuang), tang-kuei (danggui), ophiopogon (maimendong), salvia (danshen), lily (baihe), zizyphus (suanzaoren), biota (baiziren), polygonatum (yuzhu), polygonatum root (huangjing), (hehuanpi), fushen (fushen).

Representative Formulas: Ginseng and Zizyphus Combination (Tianwang Buxin Dan); Cinnabar Sedative Pills (Zhusha Anshen Wan).

UPFLARING HEART FIRE (xin huo shang yan): primary symptoms are restlessness; mouth ulcers; palpitations; insomnia. Secondary symptoms include heat sensation in the chest; flushed face; thirst; dark or red urine; constipation; and in serious cases, outbreaks of madness. The tongue typically presents with a red body or a bright red tip; the pulse tends to be forceful and rapid.

Representative Herbs: gardenia (zhizi), coptis (huanglian), ox gallstone (niuhuang), rhinoceros horn (xijiao), antelope horn (lingyangjiao), (lianzixin), scrophularia (xuanshen), raw rehmannia (sheng dihuang), forsythia (lianqiao), ophiopogon (maimendong), phragmites (lugen), lithospermum (zicao).

Representative Formulas: Purge the Heart Decoction (Xiexin Tang); Rehmannia and Akebia Formula (Daochi San).

HEART QI DEFICIENCY (xin qi xu): primary symptoms are palpitations accompanied by shortness of breath that get aggravated by physical activity; mental and physical fatigue; sensitivity to wind and drafts; spontaneous sweating. Secondary symptoms include stuffy sensation or dull pain in the chest; pale face color; shallow breathing; low voice and disinclination to talk. The tongue is typically pale; the pulse tends to be fine and weak or irregular.

Representative Herbs: ginseng (renshen), codonopsis (dangshen), astragalus (huangqi), cinnamon twig (guizhi), fushen (fushen), polygala (yuanzhi), baked licorice (zhi gancao).

Representative Formula: Nourish the Heart Decoction; Astragalus and Zizyphus Combination (Yangxin Tang).

HEART YANG DEFICIENCY (xin yang xu): primary symptoms are palpitations; shortness of breath that gets aggravated by physical activity; cold extremities; and general sensation of physical coldness. Secondary symptoms include sensation of stuffiness or pain in the chest; pale or ashen face color; shallow breathing; disinclination to talk; aversion to wind and drafts; spontaneous sweating; colorless urination; loose stools. The tongue typically presents with a pale body and a thin, white and moist coating; the pulse tends to be deep, forceless and slow, or fine and weak, or irregular.

Representative Herbs: cinnamon twig (guizhi), aconite (fuzi), dry ginger (ganjiang), polygala (yuanzhi), bakeri (xiebai), fushen (fushen), astragalus (huangqi), baked licorice (zhi gancao).

Representative Formulas: Cinnamon and Licorice Combination (Guizhi Gancao Tang); Protect the Source Decoction (Baoyuan Tang).

HEART QI AND BLOOD DEFICIENCY (xin qi xue liang xu): primary symptoms are palpitations; shortness of breath; insomnia; vivid dreaming; dizziness; pale or ashen face color. Secondary symptoms include mental and physical fatigue; spontaneous sweating; shallow breathing; disinclination to talk; pale lips and nails; dry and brittle hair. The tongue is typically pale and tender; the pulse tends to be fine and weak.

Representative Herbs: astragalus (huangqi), ginseng (renshen), codonopsis (dangshen), cinnamon twig (guizhi), fushen (fushen), baked licorice (zhi gancao), tang-kuei (danggui), cooked rehmannia (shu dihuang), peony (baishao), gelatin (ejiao), salvia (danshen), longan (longyanrou), millettia (jixueteng).

Representative Formulas: Tang-kuei and Ginseng Eight Combination (Bazhen Tang); Ginseng and Longan Combination (Guipi Tang).

HEART QI AND YIN DEFICIENCY (xin qi yin liang xu): primary symptoms are palpitations and shortness of breath that get aggravated by physical activity; insomnia; vivid dreaming; mental and physical fatigue; heat sensations in the palms and soles; pale face with flushed cheeks. Secondary symptoms include forgetfulness; spontaneous sweating or night sweats; low voice; dry mouth and throat; low-grade fever or heat sensation. The tongue typically presents with a red and tender body with little moisture and a thin white coating or little coating; the pulse tends to be fine or fine and rapid.

Representative Herbs: ginseng (renshen), pseudostellaria (taizishen), glehnia (bei shashen), polygonatum root (huangjing), astragalus (huangqi), baked licorice (zhi gancao), fushen (fushen), ophiopogon (maimendong), raw rehmannia (sheng dihuang), dendrobium (shihu), schizandra (wuweizi).

Representative Formulas: Baked Licorice Combination (Zhi Gancao Tang); Generate the Pulse Powder; Ginseng and Ophiopogon Formula (Shengmai San).

HEART BLOOD STAGNATION (xin xue yu zu): primary symptoms are palpitations and sensations of stuffiness and pain in the chest (pain is piercing or stabbing, comes and goes, or comes on suddenly; it may reflect into the left arm, shoulder, or upper back); in serious cases this condition may cause loss of consciousness, as may happen during a heart attack. Secondary symptoms include purplish discolorations on the face, lips, or nails; cold extremities; spontaneous sweating. The tongue typically presents with a purplish body or with purple spots on the sides or on top, the pulse tends to be hesitating or irregular, or in acute emergency cases may seem to be "on its way out."

Representative Herbs: persica (taoren), carthamus (honghua), salvia (danshen), tang-kuei (danggui), cnidium (chuanxiong), red peony (chishao), curcuma (yujin), pteropus (wulingzhi), bulrush (puhuang), cinnamon twig (guizhi), chih-shih (zhishi), bakeri (xiebai), trichosanthes fruit (gualou), aquilaria (jiangxiang).

Representative Formulas: Persica and Achyranthes Combination (Xuefu Zhuyu Tang); Coronary Number II (Guanxin Er Hao); Pteropus and Bulrush Formula (Shixiao San) plus Chih-shih, Bakeri, and Cinnamon Combination (Zhishi Xiebai Guizhi Tang); for loss of consciousness, may have to include Ginseng and Aconite Combination (Shen Fu Tang).

WATER QI ENCROACHING ON THE HEART (shui qi ling xin): primary symptoms are palpitations; shortness of breath; coughing or asthmatic panting with clear phlegm; pale or ashen complexion; puffiness or edema. Secondary symptoms include dizziness; sensation of fullness in the epigastric region; panicky disposition; aversion to cold; cold extremities; mental and physical fatigue; sensation of upwards rushing qi; small amounts of clear urination. The tongue typically presents with a fat and pale body, toothmarks, and a slippery white coating. The pulse tends to be deep and fine, but often soft or slippery in the first (cun) positions.

Representative Herbs: cinnamon twig (guizhi), hoelen (fuling), atractylodes (baizhu), aconite (fuzi), dry ginger (ganjiang), alisma (zexie), polyporus (zhuling), akebia (mutong), astragalus (huangqi), codonopsis (dangshen).

Representative Formulas: Atractylodes and Hoelen Combination (Ling Gui Zhu Gan Tang); Vitality Combination (Zhenwu Tang); Hoelen Five Herb Formula (Wuling San).

ACUTE COLLAPSE OF HEART YANG (xin yang xu tuo): primary symptoms are acutely compromised mental faculties, and sudden onset of cold sweats and ice cold extremities. Secondary symptoms include palpitations; stuffy sensation in chest; blue lips; ashen face color; barely detectable voice; weak and shallow breathing. The tongue is typically pale or purplish; the pulse tends to feel as if being "on its way out."

Representative Herbs: ginseng (renshen), aconite (fuzi), dry ginger (ganjiang), baked licorice (zhi gancao), bakeri (xiebai), cinnamon twig (guizhi).

Representative Formulas: Ginseng and Aconite Combination (Shen Fu Tang); Ginseng, Aconite, Dragon Bone, and Oyster Shell Combination (Shen Fu Long Mu Tang).

PHLEGM FIRE DISTURBING THE HEART (tan huo rao xin): primary symptoms are palpitations; restlessness; disturbed mental faculties; insomnia; vivid dreaming; red face; heavy breathing. Secondary symptoms include constipation; dark urination; mad or violent behavior; uncontrolled movements; hysterical crying or laughter; incoherent screaming or swearing. The tongue typically presents with a red body and a thick yellow and greasy coating; the pulse tends to be wiry, slippery, and rapid.

Representative Herbs: bamboo skin (zhuru), rhubarb (dahuang), coptis (huanglian), gardenia (zhizi), bile treated arisaema (dan nanxing), trichosanthes (gualou), ox gallstone (niuhuang), acorus (shichangpu), curcuma (yujin).

Representative Formulas: for less serious conditions, use Harmonize the Gallbladder Decoction with Coptis (Huanglian Wendan Tang); for more serious conditions, use Lapis Drive Out the Phlegm Pill; Lapis and Scute Formula (Mengshi Guntan Wan); for violent conditions, use Rusty Iron Shavings Formula (Sheng Tieluo Yin).

PHLEGM OBSCURING THE ORIFICE OF THE HEART (tan meng xin qiao): primary symptoms are acutely disturbed mental faculties or loss of consciousness. Secondary symptoms include fever; inability to speak; seizures; stuffy sensation in chest; body pain; sudden deafness; sounds of rattling phlegm or drooling sputum; thirst but no desire to drink. The tongue usually presents with a thick yellow and greasy coating; the pulse tends to be soft or slippery and rapid.

Representative Herbs: curcuma (yujin), acorus (shichangpu), polygala (yuanzhi), bamboo sap (zhuli), fritillaria (beimu), rhino horn (xijiao), gardenia (zhizi), coptis (huanglian), forsythia (lianqiao), bamboo leaf (zhuye), moutan (mudanpi), talc (huashi).

Representative Formulas: Acorus and Curcuma Decoction (Changpu Yujin Tang); Guide Out the Phlegm Decoction (Daotan Tang) plus orifice opening substances (acorus, curcuma, polygala); Great Treasure Pill; Rhinoceros and Amber Formula (Zhibao Dan).

HEAT INVADING THE PERICARDIUM (re xian xinbao): primary symptoms are high fever; clouded consciousness; delirious talk. Secondary symptoms include cold extremities; restlessness; fever blisters; eruption of macules; seizures; nausea. The tongue is typically scarlet red with a dry surface or a yellow coating; the pulse tends to be rapid or slippery and rapid.

Representative Herbs: ox gallstone (niuhuang), rhino horn (xijiao), curcuma (yujin), acorus (shichangpu), bamboo leaf (zhuye), (lianzixin), scrophularia (xuanshen), ophiopogon (maimendong).

Representative Formulas: Clear Heat in the Ying Layer Decoction (Qing Ying Tang); Ox Gallstone Pacify the Palace Pill; Bezoar and Curcuma Formula (Angong Niuhuang Wan); Purple Snow Pellet (Zi Xue Dan); Ox Gallstone Rectify the Qi Pill (Niuhuang Chengqi Wan).

HEART AND KIDNEY FAILING TO LINK (xin shen bu jiao): primary symptoms are restlessness; insomnia; vivid dreaming; palpitations; forgetfulness; spermatorrhea or premature ejaculation. Secondary symptoms include dizziness; tendency to easily get startled; ringing in the ears; tidal heat sensations; night sweats; sore and weak lower back and knees; dry throat; flushed cheeks; dark and scanty urination or nocturia; constipation. The tongue typically presents with a red body and little or no coating; the pulse tends to be fine and rapid.

Representative Herbs: raw rehmannia (sheng dihuang), asparagus root (tianmendong), ophiopogon (maimendong), scrophularia (xuanshen), salvia (danshen), schizandra (wuweizi), fushen (fushen), lotus seed (lianzi), anemarrhena (zhimu), coptis (huanglian), phellodendron (huangbai), cinnamon bark (rougui).

Representative Formulas: Coptis and Gelatin Combination (Huanglian Ejiao Tang); Connecting Pill (Jiaotai Wan).

From Li Zhongzi, A Primer of Medical Objectives (Yizong Bidu), 1637:

The Classic states: 'Whenever we treat a disease, we must approach it at the base.' Base here means root or source. Every stream on earth has a source, and every plant has a root. If all murky sediments settle at the source, the downstream waters will naturally be clear and fresh, and if we water a root, it will grow and branches will sprout; these are the laws of nature. The experienced physician, therefore, will always consider the source.

However, the body's source is differentiated into a prenatal and a postnatal aspect. The prenatal source is the kidney; the kidney is associated with the direction north and the phase element water-water being the first offspring, in Taoism, of heavenly Oneness. The postnatal source of the body is the spleen; the spleen is known as the Central Palace and associated with the phase element earth-earth being the mother of every living thing.

From Zhuang Yuanchen, Shujuzi: Inner Chapters (Shujuzi Neipian), Ming Dynasty:

The kidney is the ocean of the human body. Since oceans are situated on a lower level than the earth's streams and rivers, they draw every one of them to form one large body of water. Oceans may appear vast and inexhaustible, yet they still drain off some of their seemingly unlimited supply. One way of drainage is called 'going to ruins,' meaning the water drains down into the earth from where it will not return. The other way of drainage is called 'dwelling with the stars,' meaning the water steams toward the sky and later rains down to earth again, where it dissipates into rivers and streams and eventually returns to the ocean. This is the water that circulates between heaven and earth, always striving to keep an equilibrium between the extreme states of drought and flooding.

In the context of the human body only the kidney can be compared to the workings of this natural cycle. All the essences and fluids of the body's various pathways pour into the kidney. After the kidney has assembled the essential fluids of the body's vessels, it also experiences two ways of drainage: one way is through the sexual urge which draws the essence downward to the sexual centers; once it exits from here it cannot come back into the system, so this is just like the ocean "going to ruins." The other way is the upward dispersal by way of the suctioning affect of true qi, which draws the body's combined essences all the way up to the flower pond (mouth); from here it moves down through the throat into the stomach, lubricating the five organ networks, nourishing all of the body's pathways, and finally returning to the kidney. This is the microcosmic process of ascending and descending that can be compared to the ocean 'dwelling with the stars.'

Those who are knowledgeable in the art of nourishing life take care to shut off the lower exit [of jing via ejaculation] while striving to keep the upper pathway [of jing, nourishing the organs and brain] open and unobstructed. In this fashion, there will be a nourishing cycle that is free of leaks. Physical vitality (jing) and mental clarity (shen) will be abundant, nutritive qi (ying) and protective qi (wei) will be strong, inside (water essence) will be sufficient to control fire, and outside (qi) will be sufficient to ward off noxious influences. This is what the art of expelling disease and the art of longevity is all about.

From Zhang Huang, A Compendium of Illustrated Texts (Tushu Bian), Ming Dynasty:

In relation to the other organ networks, the kidney is situated in the lowest position. It is associated with the phase element water, and it is in charge of storing essence (jing). Just like water was the first substance to emerge from heavenly oneness, the kidney is the source of the human body, the initial sprout of physical life.

Everything between heaven and earth that is made from qi and blood has the urge to mate. Once fire and water separate and desire finds a match, the essence leaves the source, and what creates the body will turn into what kills the body. If you are a student of the Book of Change (Yijing) and align your desires by fooling around with the lofty hexagram 41 [Sacrifice, Decrease], then this is like being worried about floods at one moment and about water leakage the next-you 'sacrifice' again and again, thus using yourself up until there is nothing left to spare. Therefore, if you want to protect your source of longevity, there is no better way than to guard yourself against sexual desires.

From Sun Yikuei, Contemplations On Unexplored Medical Topics (Yizhi Xuyu), 1584:

In the Simple Questions (Suwen) section of the Neijing it is stated: 'The kidney stores the qi of the bones and the marrow.' At another place it says: 'The black color associated with the direction north corresponds directly with the kidney; its corresponding orifices in the body are the two yin (the genitals and the anus), and its essence is stored in the kidney.' The Nanjing (Classic of Difficulties) further explains: 'This is where males store their essence.' This line does not mean that all of the essence is stored right there; the brain is also called the sea of marrow, and the kidney connects with the brain via the spine.

Master Shengsheng once said: 'Chapter 36 of the Nanjing states that there are really two kidneys, namely the left one being the actual kidney, while the right one is mingmen, the gate of life. It is this mingmen that is the seat of all physical (jing) and mental (shen) essences, and it is here that essence is stored in males, and from where the uterus branches off in females. Thus, we speak of two kidneys. Just as is said in chapter 39 of the Nanjing: 'The fact that six fu organs are paired with five zang organs means that the kidney really represents two organ systems, namely the left one being the kidney, and the right one being mingmen. And mingmen, that is the abode of jing and shen. This is where male essence is stored and where the female uterus is attached; its qi is on the same wavelength with the kidney.''

A detailed examination of both sections of the Neijing does not yield any references to a differentiation of the kidney network into two distinct parts. It was the author of the Nanjing who first made this distinction. Does this mean that the entity which the Nanjing author calls mingmen-the abode of jing and shen, the seat of the original qi, the place where males store essence and females have their uterus-is nothing but idle talk? I say we have to take this theory seriously, since it appropriately places extra weight on the kidney network by emphasizing that the original qi which lodges in the kidney is the source of our life force.

The Central Junction Classic (Huangting Jing) states: 'The kidney qi regulates the upper burner, nourishes the middle burner, and protects the lower burner.' The Collection of Central Harmony (Zhonghe Ji) states: 'Breathing through the process of opening and closing-that is what happens at the gorge of mystery (mingmen), the root of heaven and earth.' Opening and closing here does not refer to the regular action of inhaling and exhaling through the nose or mouth, but to what is called the true breath. The author of the Nanjing also said: 'The igniting spark between the kidneys (shenjian dongqi) is the origin of the various processes of human life, the base of the body's five zang and six fu organs, the root of the twelve channel pathways, the door of breath, and the source of the triple burner.'

Precisely this is what the concept of mingmen is all about. It is what the Confucians refer to with their Taiji image, and what the Taoists call the gorge of mysterious origination. If we take a close look at a bronze acupuncture statue we can easily find out that the point mingmen is not located on top of the right kidney, but right between both kidneys. This certainly proves my point.

From Chen Shiduo, A Secret Manual from the Stone Chamber (Shishi Milu), ca. 1690:

As has already laid out in detail in the Nanjing, mingmen is the master of the twelve channel networks. But even though many texts have since been written about this subject, the quintessence of mingmen still remains in the dark. Therefore I chose to bring up this topic one more time.

It is always said that mingmen is the master of the twelve channel networks. Now, what kind of master is it exactly and what does it master? Let me put it this way: if there is no fire inside us, we cannot exist. This fire must be there first so that the twelve channel networks can be imbued with the igniting spark of transformation. mingmen, therefore, is a type of prenatal fire. This fire is immaterial and dwells in water. On earth, material fire is being quenched by water. Immaterial water, on the contrary, has the ability to generate fire. Therefore, when we say that "fire is being quenched by water" we refer to material water; when we say that "fire is being fueled by water" we refer to immaterial water. And it so happens that immaterial fire can generate immaterial water, meaning that fire is not contained within fire, but within water.

Mingmen fire, is yang fire-a yang that is embedded within two yin. In the microcosmic context of the human body, mingmen is generated first, and only then the heart. Does this fact not illuminate the importance of mingmen? When the heart procures the power of mingmen, consciousness is in command, and we can relate to the outside world. When the liver procures the power of mingmen, it can plan. When the gallbladder procures the power of mingmen, it can make decisions. When the stomach procures the power of mingmen, it can absorb food. When the spleen procures the power of mingmen, it can transport. When the lung procures the power of mingmen, it can fulfill its administrating and regulating functions. When the large intestine procures the power of mingmen, it can pass on the waste. When the small intestine procures the power of mingmen, it can disseminate. When the kidney procures the power of mingmen, it can bring about physical vigor. When the triple burner procures the power of mingmen, it can keep the body's water pathways unobstructed. When the bladder procures the power of mingmen, it can store. In other words, there is not a single one among the organ networks that does not rely on the mingmen fire for warmth and nourishment.

This type of fire should be tonified rather than purged. This is done by tonifying fire within water, and especially by tonifying water within fire. In this fashion, fire can be fueled by water and at the same time be stored within water. If we just use cold or cool herbs to attack the mingmen fire, it will become weak, and how could it then nourish the twelve channel networks? This is what is really meant by the Neijing statement 'when the master is dim, the twelve officials are all in a state of crisis.' Doesn't that strongly emphasize the importance of mingmen?

From Tang Zonghai, A Refined Interpretation of the Medical Classics (Yijing Jingyi), Qing Dynasty:

The root of the triple burner is in the kidney, more precisely right between the two anatomical kidneys. Right there is a greasy membrane that is connected with the spine. It is called mingmen, and constitutes the source of the three burners.

From Zhang Shanlei, A Revised Edition of Master Zhang's Treatise on the Organ Networks (Zhang Shi Zangfu Yaoshi Buzheng), ca. 1918:

The triple burner is really a name for the function of the body's ministerial fire. It is the process of disseminating original qi from mingmen, which is in charge of ascending and descending, and absorbing and excreting. It roams in between the heaven and earth of the body's landscape, and commands all bodily qi-the qi of the five zang and the six fu organs, the protective qi (wei) and the nutritive qi (ying), the qi in the channels and collaterals, and the qi on the top, the bottom, the left, and the right. Its unofficial name is therefore the central store house of clear qi. The upper part is in charge of absorbing, the middle part is in charge of transforming, and the lower part is in charge of excreting.

From Sun Yikui, Mysterious Pearls of Wisdom (Chi Shui Xuan Zhu), 1584:

The so called triple burner is embedded in the greasy membrane of the diaphragm, that is the hollow space between the five zang/six fu organs and the connective pathway through which food and grain must pass. The qi of the triple burner is contained and active within this space, steaming the diaphragm, reaching out to the skin, differentiating the flesh, and setting everything around it in motion. The regions that it reaches are labeled according to their location, that is why we speak of the upper burner, the middle burner, and the lower burner. Although the triple burner does not have any structural reality to it, it has a distinct location that is determined by the structural entities surrounding it.

From Shen Jin'ao, Illuminating Lantern on the Origins of Complex Diseases (Zabing Yuanliu Xizhu), 18th century:

What we call the triple burner is actually the corridor above and below the stomach. The triple burner and its associated regions thus entirely belong to the stomach, and what it oversees is primarily the functioning of the stomach. The triple burner qi is utilized to ferment and cook the food. Together with the stomach, the triple burner is located in front of the taiyin spleen network-a place that the roaming ministerial fire calls home. The term "burner," therefore, refers to the triple burner's function of cooking everything.

From Li Dongyuan, Illuminating the Science of Medicine (Yixue Faming), 13th century:

The triple burner is an entity that has a name but no structural form. It is in charge of all bodily qi, and it is a functional manifestation of the three treasures [jing, qi, shen]. All of the body's physiological movements, its unobstructed ins and outs and ups and downs, therefore, rely on the triple burner-the process of breathing in and breathing out, the ascending and descending motion of qi, and the absorption and excretion of food and water. The upper burner is located underneath the heart; it is in charge of storing without draining. The middle burner is in the center of the epigastric region; it is in charge of fermenting and cooking food and water. The lower burner is beneath the umbilicus; it is in charge of differentiating the clear from the turbid, and it drains without storing. The driving source behind all three of these functions, however, is the middle burner.

From Chen Nianzu, The Three Character Classic of Medicine (Yixue Sanzi Jing), Qing Dynasty:

The term triple burner refers to the qi that circulates in the upper, middle, and lower burners. Burner means heat. Only when the entire body cavity is permeated with hot qi can the body's water ways be open and regulated. The triple burner is the fu organ that forms a zang/fu pair with the pericardium, and thus belongs to the phase element fire. In other words, if the heating qualities of the upper burner are out of control, water will assault the upper plains of the body. If the middle burner is out of control, water will stagnate in the epigastric region. If the lower burner is out of control, water will disturb bowel movements and urination. On the other hand, if the triple burner qi is healthy and in control, the body's channels and collaterals will be open and its water ways will be disinhibited. It is for this reason that the triple burner is called the official in charge of uninhibited water flow.

Jing is the Chinese designation for the essential fluid of our physical body. The archaic Chinese character for jing denoted the most refined essence obtained from rice (which is the main staple of the Oriental diet, so this means the refined essence from food). The basic yin (matter) from which all yang (physical action) springs is jing. In classical Chinese medical texts, jing is sometimes referred to as the body's "original water" with water representing the ultimate yin ("original fire" being the ultimate yang).

Water has a tendency to drain downward. The kidney, the lowest of the organ networks, is where the body's water assembles and goes into storage until needed elsewhere. If the kidney function is weak, its storage capability will become inhibited and jing will leak from the body. Due to the Daoist belief that the jing is lost when a man excretes semen (of particular concern, when an elderly man, who already had deficiency of jing through aging, excretes semen), virtually all of the ancient medical texts mention spermatorrhea (a code for release during the disallowed practice of masturbation, wet dreams, and ejaculation during intercourse when the attempt is being made to prevent it) as a condition to be treated, since it indicates a breach of the kidney's function of safeguarding and storing jing. According to the Daoist ideal, except during early adulthood, men should refrain from releasing semen, or, at the very least, experience this infrequently.

Therefore, excessive sexual indulgence by males is considered to be a major health hazard in all genres of traditional Chinese writing. Since most men cannot control their urge to ejaculate, every intercourse means an irrevocable giving away of jing. Although Chinese medical texts consent that this may be affordable for young men (who have a rich supply of jing and who can easily replenish jing through post-natal sources), they generally warn that the health of elderly males will suffer serious consequences from frequent ejaculations. "What gives life will take life" is therefore a common admonition that spans two thousand years of Chinese medical literature.

While most Daoist and medical writings take up both the general topic and the detailed techniques of safeguarding jing, it is the realm of literature which best reflects the Chinese fear of continuous jing loss by way of sexual indulgence. The epic Ming Dynasty novel, Flower In the Golden Vase (Jin Ping Mei), narrates the story of the erotomaniac Ximen Qing who peddles his money and political influence to assemble a harem of six women, then resorts to tonic drugs to bolster his flagging virility, and finally comes to a horrid end after a final ejaculation of "mercury-like fluid, followed by blood and a gust of cold air." A Daoist physician who is called to the deathbed comments: "The candle flickers once the oil is used up." Both mercury and lamp oil are often used metaphors for the kidney jing. To avoid such a gruesome death, the handsome protagonist of the second moralist novel of the Ming dynasty, Prayer Mat of Flesh (Rou Putuan), decided to become a Buddhist hermit, cut off his surgically amplified penis, and utilize his jing for spiritual cultivation.

Although the word jing is synonymous with the Chinese word semen, the seminal fluid represents only one form of jing. Other dense fluid essences such as saliva (particularly the kind that gets spontaneously excreted during meditation), vaginal fluids, breast milk, or blood are all regarded to be different transformations of one and the same jing; these are refined essences. Female "leakage" problems, such as metrorrhagia or leukorrhea occurring in older women, are therefore taken seriously for the same reasons as loss of semen in men. Daoist body science even features a special category called female alchemy (nu dan), wherein adepts are instructed in the conservation of (menstrual) blood and its transformation into physical and spiritual energy.

The jing stored in the kidney can be differentiated into prenatal jing and postnatal jing. Prenatal jing contains the information that is given to us before birth (we would today describe it as genetic information) that is intimately linked to the growth and maturation of an individual, which differs for men and women. The defining passage in the Neijing for women reads: "At the age of seven, the kidney qi [the physical action generated by the material basis of kidney jing] in females is strong, and the teeth come in. At the age of two times seven, the tiangui (stage of hormonal and reproductive maturity) arrives, the conception vessel opens, the penetrating vessel flourishes, menstruation is regular, and pregnancy becomes possible." With regard to male physiology: "At the age of eight, the kidney qi solidifies in males and teeth develop. At the age of two times eight, the kidney qi flourishes, the tiangui arrives, ejaculation occurs, and it becomes possible to have intercourse with females and beget children...; at the age of seven times eight, the liver qi is exhausted, the tendons are unable to facilitate smooth movement, the tiangui is dried up, jing is sparse, the kidney system is exhausted, and symptoms of physical aging are plentiful."

Postnatal jing is the nutritive essence distilled from food by the spleen/stomach, and used to provide a constant flow of nourishing dew to the other organ networks. If all the networks are plentifully supplied, the surplus of the body's vital fluid transformation is stored in the kidney. The Neijing states: "The kidney is in charge of water, and it receives the essences of the other zang and fu organ networks and stores it." Before birth, prenatal jing forms the material basis for the development of postnatal jing. Once born, postnatal jing continuously boosts the body's limited supply of prenatal jing. Both forms of essence compose an indivisible entity.

Kidney jing encompasses both kidney yin and kidney yang, often referred to as the body's original yin and original yang. Kidney qi is produced by the dynamic interaction between the two, specifically the action of functional/warming kidney yang steaming the material kidney yin. Kidney yin is the source of all material body fluids, in charge of nourishing and moistening all organ networks. Kidney yang, sometimes also called true yang, is the source of all types of yang qi. It is the driving force behind all processes of warming, generation, and transformation. The yin and yang aspects of the kidney both rely on each other and control each other. The proper balance between kidney yin and kidney yang is an important precondition for health.

Will, determination, and power of memory are attributed to the kidney. The ability to keep a secret is attributed to the kidney's power of retention and safeguarding against leakage. The Neijing defined that "the kidney stores jing, and jing houses will power." In turn, if kidney jing becomes exhausted, a weak will and poor memory will result.

Fluids reach the kidney after they have been absorbed by the stomach, raised upwards by the spleen, and sprinkled downwards by the lung. At this point they become differentiated into clear and turbid aspects by virtue of the transformative powers of kidney yang. The clear part of fluid essence returns to the lung, from where it moistens each one of the zang organs. From the lung, it turns into nasal discharge, or sweat, or saliva, or tears; and it differentiates into jing, blood, jin (liquids, that is the thinner fluids moistening the muscles), and ye (the denser fluids lubricating the joints and bone marrow). The turbid part feeds into the bladder, where it is being transformed into urine, and excreted.

Bone marrow is considered to be a transformation of kidney jing that has the specific task of nourishing the bones. It is differentiated into bone marrow, spinal marrow, and brain marrow. Spinal marrow feeds into the brain, where the densest concentration of "marrow" can be observed. The brain is therefore also called the sea of marrow.

If kidney jing is plentiful, both the bone (supporting the body) and the brain (supporting the mind) will be at a level of ideal strength. On the other hand, a deficiency of kidney jing will bring about brittle bones and a listless spirit. As the Neijing puts it: "The kidney is the master of physical strength; it produces exquisite movements/actions."

Since the teeth are considered to be the "surplus of the bones," they also rely on the nourishment of the kidney. If the jing is plentiful, the teeth are firm; if not, they come loose or fall out.

The hair's growth process is governed by the waxing and waning of kidney qi. Again the crucial Neijing quote: "At the age of seven, a female's kidney qi is in high gear, the second teeth come in and the hair grows." Ancient texts often consider the head's hair to be a direct outgrowth of the brain, which would relate it to the kidney. The growth pattern and general luster of the hair is an important indication for the condition of prenatal jing.

Although the process of breathing is governed by the lung, the containment of incoming qi within the lower burner is governed by kidney qi. Only if kidney qi is plentiful and its grasping power sufficient can the qi passages of the lung be unobstructed and the breathing be harmonious. If the kidney is weak and the breath cannot "root" in the kidney, disease will eventually arise. Shallow breathing, particularly in patients suffering from chronic asthma, is therefore often associated with a kidney qi deficiency. In this situation, the breath gets stuck above the diaphragm and cannot descend into its rightful abode, the lower dantian. This aspect of the kidney is one reason why there is such an intent focus on abdominal breathing in Oriental cultures.

The kidney and bladder form a zang-fu pair: "The kidney is connected with the bladder," states the Neijing; "the bladder is the store house of the liquids and humors." This statement reminds us that the bladder, similar to the gallbladder and the small intestine, not only excretes unwanted waste materials, but comprises a temporary station along the body's complex highway of vital fluid transformation. Bladder function, particular its function of "opening and closing," is largely dependent on the power of kidney qi. If kidney qi is strong, normal water metabolism will take place. The storage and excretion process of water through the bladder is thus intimately related to the general functioning of the kidney.

The ears, which faintly resemble the kidneys in shape, are thought to reflect the condition of kidney jing. Large ears and sharp hearing indicate an excellent condition of kidney jing. As people grow older, they not only become more forgetful, but their power of hearing decreases (and sometimes their ears shrivel up) as their jing depletes. As the original statement of the Neijing goes: "The kidney qi communicates with the ears; if the kidney functions properly, the ears can distinguish the five essential sounds."

Kidney qi, due to its mother organ's close proximity to the openings in the lower burner, governs the opening and closing function of the "two private parts," including sexual functions like erection, ejaculation, and lubrication of the vaginal tract, and maintenance of fecal continence (as well as urinary continence via the control of the bladder).

The concept of mingmen, the vital gate of life, is an integral part of the kidney system. The Nanjing (Classic of Difficulties) elaborated on basic Neijing theory by figuratively differentiating these two aspects of the kidney in structural terms, thereby initiating a medical theory that was later referred to as the mingmen school: "There are two kidney parts. Actually, not both of them are kidneys. The left one is the kidney, the right one is mingmen." The classic then goes on to elaborate that mingmen is the place "where the entirety of bodily jing and shen is at home, and where the original qi is generated." "It is the root of all zang-fu networks, the foundation of the twelve channels, the gate of breath, and the source of all three burning spaces." Later medical scholars argued that mingmen is an immaterial force that could not be physically located in the right kidney. Rather, its location is the central point on the spine between the two anatomical kidneys and opposite the umbilicus, thus forming a "posterior dantian." The Chinese name for the acupuncture point located there is mingmen (GV-4).

The fire lodged within kidney water is often referred to as the body's ministerial fire (xiang huo), as opposed to the imperial fire (jun huo) of the heart. In its role of the "minister" serving the higher centers, it warms the spleen, ripens food, grasps lung qi, and gives volume to a person's voice.

The triple burner, a fu organ that is said to pass through and connect all of the body's three burning spaces, stimulates qi transformation with a specific focus on water metabolism. It keeps the body's water ways unobstructed and smoothly operating. These functions of the triple burner are intimately tied to the kidney and bladder. The Neijing says: "The upper burner is like a mist, the middle burner is like a swamp, and the lower burner is like a ditch," referring to the essence misting activity of the lung on top, the fermenting action of the spleen/stomach at the center, and the canalization of water in the lowest part of the torso.

Injury to Kidney (Yin) and Mingmen (Yang) Fire: if the kidney's ability to store jing becomes disturbed, a person's growth patterns and reproductive ability will be affected; infertility, hair and tooth loss, slow physical development, or softness and malformation of the bones may result.

If within the kidney jing the crucial controlling/generating balance between kidney yin and kidney yang becomes disturbed, different symptom patterns may arise. Typical manifestations of hyperactivity of yang due to kidney yin deficiency are burning sensation in the palms and soles, tidal heat sensations, night sweats, spermatorrhea, or sexual dreams. When the kidney yang is exhausted and thus unable to execute its ministerial warming function, symptoms of listless spirit may result: sore lower back and knees; cold sensations in the body and its extremities; inhibited urination or frequent and profuse urination; early morning diarrhea; asthmatic panting upon slight physical exertion; difficult breathing; impotence and premature ejaculation; or infertility due to a "cold uterus." If there is evidence of kidney deficiency without obvious cold or heat symptoms, this symptom complex is usually referred to as kidney qi (or kidney jing) deficiency.

It is important to understand the intimate relationship of kidney yin and kidney yang, and that prolonged kidney yin deficiency will eventually influence kidney yang and vice versa. This phenomenon is usually called a deficiency of kidney yin implicating kidney yang, or a deficiency of kidney yang implicating kidney yin.

Changes in Water Metabolism: since the kidney is said to be in charge of water, all pathological changes involving water are in some way associated with the kidney. If there is a lack of kidney yang, the body's general process of qi transformation will suffer, and consequently water metabolism will be inhibited. As the Treatise on Blood Diseases (Xuezheng Lun) explains: "If there is not enough yang qi, pathological water accumulations will turn into phlegm and distress the heart or attack the lung, or cause symptoms of edema, abdominal pain accompanied by a sensation of qi rushing upwards, or diarrhea and intense cold."

Most cases of phlegm or edema occur when the yang fire is unable to transform yin water. Figuratively speaking, the kidney is the general commanding the two water fu organs which are mainly involved in the transportation and transformation of water, namely the triple burner and the bladder. As the Neijing says: "The shaoyang [triple burner] belongs to the kidney; above, the kidney connects with the lung, and thus has two fu organs under its command [triple burner and bladder]."

Therefore, if there is not enough kidney yang, the upper burner cannot properly distribute fluids, the middle burner cannot properly steam and ripen food and separate the clear from the turbid, and the lower burner cannot properly transform qi, thus influencing the opening and closing ability of the bladder (causing excessive or inhibited urination, as in bed wetting, frequent urination, nocturia, etc.).

Moreover, since urine is manufactured from body fluids which are in part produced by the kidney, a deficiency of kidney water will always involve a deficiency of fluids, causing inhibited urination. Along the same lines, too much urination will eventually harm the body's fluid supply.

Emotional Influences on Proper Kidney Function: the kidney is said to house the force of will power and determination. Will power, therefore, relies on nourishment by kidney jing. If jing is weak, then will power and its sustained expression (memory) will also be weak.

Intense or prolonged fear, the emotion associated with the kidney, will cause injury to the kidney qi, resulting in impotence, spermatorrhea, or the gradual development of cowardly behavior. The other way around, a physical deficiency of kidney jing can cause a disposition for panicky and fearful behavior.

Kidney Disorders Causing Pathological Changes in the Bones, the Marrow, the Hair, and the Ears: if kidney jing is sufficient, the continuous production of high quality marrow is assured, resulting in properly nourished and, thus, firm and strong bones. Otherwise the skeletal structure will be weak, or structural changes such as osteoporosis might occur.

If the kidney is harmed by pernicious qi affecting the kidney jing and consequently the marrow and bones, there will be symptoms of weak and sore waist and legs, or even atrophy of the legs causing severely limited mobility. As the Neijing states: "If kidney qi is pathologically hot, the lumbar spine will be inhibited, the bones will become brittle and the marrow scorched, and atrophy of the bones will result."

For the same reasons, symptoms of loosening and deteriorating teeth, or the drying, greying, and gradual falling out of hair are related to the state of the kidney's jing qi. Since the ears and the associated sense of hearing also depend on nourishment by the kidney's jing qi, ringing in the ears, loss of hearing, or deafness are typical symptoms for various aspects of kidney deficiency.

Moisten the kidney (tonify kidney yin) (zi yin; bu shen yin): rehmannia (dihuang), tortoise shell (guiban), asparagus root (tianmendong), lycium fruit (gouqizi), morus fruit (sangshenzi), ligustrum (nuzhenzi).

Warm the kidney (strengthen yang; tonify the vital flame of life) (wen shen; zhuang yang; bu ming huo): aconite (fuzi), cinnamon bark (rougui), sulphur (liuhuang), morinda (bajitian), deer antler (lurong), cnidium fruit (shechuangzi), cistanche (roucongrong).

Complement jing and tonify the marrow (tian jing bu sui): animal bone marrow (dongwu jisui), animal brain (naosui), placenta (ziheche), deer antler (lurong), antler gelatin (lujiaojiao), tortoise plaster gelatin (guijiao), cordyceps (dongchong xiacao).

Restore the storing action of the kidney (astringe jing; stop vaginal discharge; curb frequent and profuse urination) (gu shen; se jing; zhi dai; shou se xiao bian): schizandra (wuweizi), cornus (shanzhuyu), alpinia (yizhiren), rubia (fupenzi), mantis egg case (sangpiaoxiao), rose hips (jinyingzi).

Restore the kidney's function of grasping and retaining qi (na qi gui shen): schizandra (wuweizi), psoralea (buguzhi), gecko (gejie), cornus (shanzhuyu), aquilaria (chenxiang).

Aid the transformation of bladder qi (hua pangguang qi): cinnamon twig (guizhi) and hoelen (fuling), cinnamon bark (rougui), lindera (wuyao), fennel (xiao huixiang), saussurea (muxiang), citrus seed (juhe), litchi seed (lizhihe).

Open and disinhibit the water passages of the bladder and the triple burner (tongli pangguang, sanjiao): alisma (zexie), hoelen (fuling), polyporus (zhuling), talc (huashi), akebia (mutong), tetrapanax (tongcao), tokoro (pixie), polygonum (bianxu), lygodium (haijinsha).

Clear kidney heat (moisten yin and descend deficiency fire) (qing shen re; zi yin jiang huo): anemarrhena (zhimu), phellodendron (huangbai), morus bark (digupi), eclipta (hanliancao).

Discharge kidney fire (purge fire with salty and cold materials) (xie shen huo; xian han xie huo): salt (qingyan), halite (qingyan), urine (tongbian), calcitum (hanshuishi).

Since the kidney is the representative lower burner organ, it generally needs to be addressed with high amounts of heavy and sticky substances. The 18th century fever school authority Wu Jutong once described this characteristic in graphic terms: "Lower burner therapy is like a weight-if it is not heavy enough, it does not reach the bottom."

Kidney disorders are generally of a cold and deficient nature. Kidney therapy, therefore, needs to focus primarily on the tonification of deficiency; purging of excess is a definite taboo. If kidney water is deficient, the kidney needs to be tonified by moistening yin. If kidney jing is deficient, it needs to be replenished by supplementing jing and tonifying the bone marrow. If kidney yang is deficient, the kidney needs to be tonified by using modalities that strengthen yang. In the more advanced scenario of mingmen fire exhaustion, materials that warm and tonify the vital flame of life need to be employed.

Since the kidney has both yin and yang aspects, pathological situations may arise from an imbalance in the ratio of kidney yin and kidney yang. The most typical example is the upflaring of deficiency fire due to a deficiency in kidney water, which calls for a descending action that re-anchors the floating fire in the yin waters of the kidney. This is primarily achieved by the use of yin tonics which will bring the diminished yin level back to full capacity and thus naturally extinguish the deficiency type of pathological heat. If yang deficiency has begun to implicate yin, both jing and marrow should be supplemented and the vital flame of life be warmed and tonified. If both kidney yin and yang are deficient, both the various aspects of the kidney and the vital flame of life should be tonified.

In the common scenario of spleen and kidney deficiency, both spleen and kidney yang need to be tonified. In case of lung and kidney deficiency, both lung and kidney yin need to be moistened. In chronic asthma patients where kidney deficiency results in an inability of the kidney to grasp the descending qi from the lung, the kidney needs to be warmed with substances that specifically assist with the action of grasping and retaining qi, such as gecko (gejie) and schizandra (wuweizi). If lung metal fails to properly generate kidney water, kidney yin needs to be moistened indirectly by nourishing the yin of its mother system, the lung. If kidney water fails to nourish its son, liver wood, the liver needs to be supported by moistening kidney yin and/or kidney jing. In the case that kidney deficiency has caused an exhaustion of the earth network, the lower burner's vital flame of life needs to be rekindled with warming substances in order to provide the transformative forces of the middle burner above with the activating heat they require.

If the extended water network (including the kidney, the bladder, and the triple burner) is compromised by a damp heat condition, the dampness should be disinhibited with materials of a cooling nature that have a specific affinity to the lower burner, such as alisma (zexie), polyporus (zhuling), and talc (huashi). If the transformative powers of the bladder and the triple burner fail due to an exhaustion of the kidney's vital flame of life, then this type of pathological water accumulation needs to be transformed by primarily warming kidney qi, and secondarily by adding several herbs that directly move out the pathological water. If phlegm, dampness, or water rheum stagnate internally, phlegm damp needs to be disinhibited, and water rheum driven out.

If the kidney has been damaged due to chronic illness, exaggerated emotions, or excessive sexual activity, a change of the situation or life style that has originally caused the condition is imperative. Simultaneously, the recovery of the kidney system can be supported by prescribing a selection of tonic agents that moisten yin, strengthen yang, or nourish jing and marrow.

As the water network, the kidney has an aversion to dry influences. It would be particularly detrimental to exclusively employ bitter and drying substances in a situation where the kidney yin is deficient. Perhaps unexpectedly, the Neijing recommends pungent flavors to counteract dryness in the kidney; these pungent flavors aid the lung in distributing moisture to the kidney. In clinical reality, herbs like cuscuta (tusizi) and cnidium fruit (shechuangzi) fit this category. The kidney strives for a state of guarded firmness and tight solidity. If the storage fortress of the kidney is properly buttressed, precious essence will not leak out. Many bitter materials, although they should be used cautiously for the reasons just mentioned, have a stabilizing affect on kidney yin. Anemarrhena (zhimu), an herb that is both bitter and moistening, and phellodendron (huangbai) are the prime substances used in situations of continuous jing leakage, particularly lower burner deficiency fire fueling obsessive sexual urges, excessive masturbation, recurrent sexual dreams, spermatorrhea, or certain types of leukorrhea.

Salty flavors have a direct affinity to the kidney network, and are generally beneficial when used in moderation. "Salty flavors generate the kidney," comments the Neijing. Increased dietary intake of salt, usually obtained from stored foods with salt as the preserving element, taken during the water season (winter) contributes to preserving the kidney against the cold. On the other hand, salt has a percolating and leakage-promoting affect that is overall unsuitable for an organ system that is in charge of storing and metabolizing physiological jing, humors, and fluids. Therefore, excessive consumption of salty foods is discouraged, as it will harm the kidney and its affiliated body layer. "If the disease is in the bone layer," the Neijing points out elsewhere, "do not eat salty foods."

If the kidney root is damaged, many of the body's stem and branch organs have already entered a pathological state first. If kidney yin-that is the base substance from which liver yin, stomach yin, heart yin, lung yin, and the body's humors and fluids are formed-is deficient, it usually means that the condition is preceded by a yin deficiency in other organs. Similarly, the essential flame of the lower burner only flickers after the light in the upper levels has grown dim. This situation has given rise to a school of medicine that favors kidney tonification in most deficiency situations. Tonifying kidney yin and kidney yang, proponents have argued since the 13th century, means to moisten and strengthen the body's source yin/yang and thereby the yin/yang of all organ networks. However, the root status of the kidney also implies that kidney deficiency is often accompanied by inadequate spleen/stomach function. This poses a problem in light of the fact that herbal kidney therapy requires heavy amounts of sticky substances that are generally hard to digest. One attempt to remedy this situation was the addition of herbal "digestive aids" to kidney formulas such as Rehmannia Six Formula (Liuwei Dihuang Wan). Pharmacists at the renowned Beijing herb emporium Tongren Tang, for instance, used to automatically add small amounts of the aromatic cardamon (sharen) if the patient's prescription called for large amounts of the greasy kidney tonic rehmannia (dihuang). Proponents of the spleen/stomach school, on the other hand, have argued that kidney deficiency is often the result of a deficiency of its controlling network, namely spleen earth. Spleen tonification advocates have said for more than half a millennium that this should be the primary modality to regenerate the kidney system. In any case, caution needs to be exercised regarding the prescription of heavy "water" substances to patients who show signs of digestive weakness, such as poor appetite, bloating, and tendency to experience diarrhea or loose stool. A safe method for the direct tonification of lower burner source qi has been developed by the ancestors of Chinese medicine, namely Daoist practitioners of "inner alchemy." The term inner alchemy refers to Qigong exercises of the quiet, meditative kind that focus on generating warmth and fullness in the lower dantian.


KIDNEY continued

KIDNEY YIN DEFICIENCY (shen yin xu): primary symptoms are dizziness; blurry vision; ringing in the ears; sore and weak lower back or knees; burning in palms and soles; tidal heat sensations; night sweats. Secondary symptoms include dry mouth and throat; flushed face; emaciated features; premature graying of hair; low sperm count in males; decreased menstrual flow and infertility in females; forgetfulness; insomnia; spermatorrhea; premature ejaculation; heel pain; yellow urination; dry stool. The tongue typically presents with a red body and little or no coating; the pulse tends to be fine and rapid.

Representative Herbs: rehmannia (dihuang), cornus (shanzhuyu), asparagus root (tianmendong), ho-shou-wu (heshouwu), lycium fruit (gouqizi), ligustrum (nuzhenzi), tortoise shell (guiban), turtle shell (biejia), scrophularia (xuanshen), eclipta (hanliancao), anemarrhena (zhimu).

Representative Formulas: Return the Left Decoction; Achyranthes and Rehmannia Formula (Zuogui Yin); Rehmannia Six Formula (Liuwei Dihuang Wan).

KIDNEY YANG DEFICIENCY (shen yang xu): primary symptoms are pale or dark complexion; listless spirit; obvious aversion to cold; cold extremities; low sex drive; weak or cold and painful lower back and knees; early morning diarrhea; frequent urination or clear and profuse urination. Secondary symptoms include impotence; premature ejaculation; infertility; clear vaginal discharge; inhibited urination and edema; dizziness; ringing in the ears. The tongue typically presents with a pale, tender, and often toothmarked body, and a white and slippery coating; the pulse tends to be deep, slow, and forceless.

Representative Herbs: aconite (fuzi), cinnamon bark (rougui), epimedium (yinyanghuo), morinda (bajitian), psoralea (buguzhi), deer antler (lurong), curculigo (xianmao), fenugreek (huluba), cistanche (roucongrong), cynomorium (suoyang).

Representative Formulas: Return the Right Pill (Yougui Wan).

KIDNEY QI DEFICIENCY (shen qi xu): primary symptoms are dizziness; ringing in the ears; weak or sore lower back and knees; physical and mental fatigue; shortness of breath. Secondary symptoms include pale complexion; spontaneous sweating; decreased mental and physical growth rate in children; frequent urination; nocturia; spermatorrhea; premature ejaculation; asthmatic panting upon exertion. The tongue typically presents with a pale body and a white coating; the pulse tends to be fine and weak.

Representative Herbs: walnut (hutaorou), dioscorea (shanyao), eucommia (duzhong), cuscuta (tusizi), schizandra (wuweizi), cornus (shanzhuyu), morinda (bajitian).

Representative Formula: Rehmannia Eight Formula (Shenqi Wan).

KIDNEY JING DEPLETION (shen jing bu zu): primary symptoms are dizziness; ringing in the ears; weak or sore lower back and knees; low sperm count in males; amenorrhea and infertility in females; delayed mental and physical development in children. Secondary symptoms include decreased memory; slow and clumsy body movements; dull facial expressions; emaciated body structure; hair loss; loose teeth; late closing of fontanella in babies; muscular atrophy.

Representative Herbs: placenta (ziheche), deer antler (lurong), tortoise shell gelatin (guijiaojiao), cordyceps (dongchong xiacao), cooked rehmannia (shu dihuang), lycium fruit (gouqizi), cornus (shanzhuyu), eucommia (duzhong), cistanche (roucongrong).

Representative Formula: Placenta Restorative Pills (Heche Dazao Wan).

BILATERAL DEFICIENCY OF KIDNEY YIN AND YANG (shen yin yang liang xu): primary symptoms are dizziness; ringing in the ears; weak, sore, or painful lower back and knees; cold fingers and toes and/or burning sensations in palms and soles; night sweats or spontaneous sweating. Secondary symptoms include pale complexion and/or flushed face; poor memory; insomnia; vivid dreaming; listless spirit; loose teeth; dry and split hair; unsteady walk; swollen feet; asthmatic panting upon physical exertion. The tongue typically presents with a red body and little or no coating, or with a pale body and white coating; the pulse tends to be fine and rapid, or deep, slow, and weak.

Representative Herbs: cooked rehmannia (shu dihuang), ho-shou-wu (heshouwu), lycium fruit (gouqizi), ligustrum (nuzhenzi), cornus (shanzhuyu), cuscuta (tusizi), schizandra (wuweizi).

Representative Formulas: Rehmannia Eight Formula (Shenqi Wan); Five Seed Fertilize the Ancestral Force Pill (Wuzi Yanzong Wan).

THE KIDNEY QI FAILS TO EXECUTE ITS STORING ACTION (shen qi bu gu): primary symptoms include clear, frequent, and dribbling urination; enuresis; bedwetting; spermatorrhea; premature ejaculation; tendency to miscarry; clear vaginal discharge. Secondary symptoms include pale complexion; mental and physical fatigue; weak or sore back; loss of hearing; spontaneous sweating. The tongue typically presents with a pale body and a white coating; the pulse tends to be fine and weak.

Representative Herbs: schizandra (wuweizi), euryale (qianshi), rose hips (jinyingzi), mantis egg cases (sangpiaoxiao), dioscorea (shanyao), alpinia (yizhiren), dragon bone (longgu), oyster shell (muli), cuscuta (tusizi).

Representative Formulas: Golden Lock Shore Up the Jing Pill (Jinsuo Gujing Wan); Mantis Formula (Sangpiaoxiao San); Retract the Source Pill (Suoquan Wan).

THE KIDNEY FAILS TO GRASP AND RETAIN QI (shen bu na qi): primary symptoms are shortness of breath or asthmatic panting (brief inhale, longer exhale), especially following physical exertion. Secondary symptoms include pale complexion; puffy face; blue lips; emission of small amounts of urine when coughing; spontaneous sweating; general aversion to cold; cold extremities; weak or sore lower back and knees; mental and physical fatigue. The tongue typically presents with a pale body and a white coating; the pulse tends to be fine and weak, or floating and uprooted.

Representative Herbs: walnut (hutaorou), gecko (gejie), psoralea (buguzhi), schizandra (wuweizi), cooked rehmannia (shu dihuang), ginseng (renshen), codonopsis (dangshen), aquilaria (chenxiang), amethystum (zishiying).

Representative Formulas: Ginseng and Walnut Decoction (Renshen Hutao Tang); Ginseng and Gecko Powder (Shen Jie San); All Encompassing Qi Pill (Du Qi Wan).

YIN DEFICIENCY CAUSING FIRE EFFULGENCE (yin xu huo wang): primary symptoms are flushed face and red lips; restlessness; difficulty falling asleep; dry mouth and throat; burning sensation in palms and soles; tidal heat sensations; night sweats. Secondary symptoms include obsessive sexual fantasies; excessive urge to masturbate; frequent sexual dreams; dark urination; constipation. The tongue typically presents with a red body and little or no coating; the pulse tends to be fine and rapid.

Representative Herbs: anemarrhena (zhimu), phellodendron (huangbai), coptis (huanglian), raw rehmannia ( sheng dihuang), peony (baishao), cynanchum (baiwei), eclipta (hanliancao), lycium bark (digupi).

Representative Formulas: Anemarrhena, Phellodendron, and Rehmannia Formula (Zhi Bai Dihuang Wan); Lock in the Marrow Pellet (Fengsui Dan).

KIDNEY YANG DEFICIENCY CAUSING WATER EFFUSION (shen yang xu shui fan): primary symptoms are puffiness and edema (especially prominent in lower extremities). Secondary symptoms include ashen or waxen face color; inhibited urination; obvious aversion to cold; cold extremities; palpitations; stuffy sensation in chest; shortness of breath; cough or asthmatic panting accompanied by expectoration of runny and clear phlegm; heavy and painful waist; abdominal fullness; scrotal edema. The tongue typically presents with a fat, pale, and toothmarked body, and a white and slippery coating; the pulse tends to be deep and wiry; or deep and fine.
Representative Herbs: aconite (fuzi), cinnamon twig (guizhi), hoelen (fuling), curculigo (xianmao), alisma (zexie), plantago seed (cheqianzi), polyporus (zhuling).
Representative Formula: Vitality Combination (Zhenwu Tang).


From Wang Kentang and Wu Mianxue, The Compendium of Traditional Diagnosis (Gu Jin Yitong Zhengmai Quanshu), 1601:

The stomach is called the sea of grain and water; everything is assimilated here. The spleen is in charge of transportation; everything is moved by its workings. Absorbing and moving: these are the essential actions which define the spleen/stomach network as the main source of the life-sustaining postnatal energy.

From Li Zhongzi, A Primer of Medical Objectives (Yizong Bidu), 1637:

What makes the spleen the source of postnatal energy? Once a child has been born, it will feel hungry after one day without food, and it will die after seven days without food. Once we have entered the realm of the physical body, therefore, we have to be nourished by qi that is derived from food (gu qi). Once the food enters the stomach, it is transported to the six fu organs, and thus there will be qi. It will be appropriately dispensed to the five zang organs, and thus there will be blood. Human beings must rely on this type of nourishment in order to stay alive. It is for this reason that the spleen is called the source of postnatal energy.

From Cheng Wenyou, Quotes from Medicine (Yishu), 1826:

Be aware that the spleen network cannot be compared to a system of mills or mortars that grind or pound away on the incoming food. Rather, the spleen's ability to transform food and drink primarily depends on its suctioning affect: preventing the food from falling down! Every food item entering the stomach consists of both a qi component and a material component. The material component of the food naturally sinks downwards, while its qi component naturally rises upwards. Once in the stomach, the food gets "steamed" under the influence of stomach qi. Then, in the process of being separated into its material and its light parts, it is being suctioned by the qi of the neighboring spleen. In this fashion, the stomach qi is being assisted in its vital work and all of the food essence remains where it needs to be for processing-all the way until every bit of food qi has been extracted and only the material shell remains, at which time the lower gate of the stomach opens and the dregs are being discarded downwards.

From Li Dongyuan, A Treatise on the Spleen and Stomach (Piwei Lun), 1249:

The stomach is called the sea of grain and water. Once food enters the stomach, its essential energy is moved upwards to infuse first the spleen and then the lung. In this fashion, the command of spring and summer is being carried out, and the entire body receives nourishment. This is due to the influence of clear heavenly qi.

Once the ascending motion has reached its climax, this current shifts directions and flows downwards toward the bladder. In this fashion, the command of autumn and winter is being carried out, and the waste becomes processed and the flavors will manifest. This is due to the influence of turbid earth qi.

If we then regulate our daily lives by adjusting them to the prevailing energy of the seasons, if we avoid exposure to extreme cold and extreme heat, if we eat and drink in regular intervals, if we protect our shen by avoiding states of extreme anger or extreme ecstasy, and if we strive for balance by living in moderation during all four seasons, there will be peace. Otherwise, the spleen and stomach will suffer harm, and our true qi will leak downward in trickles or currents [i.e., diarrhea], with the possibility of failing to rise again. This, then, would be like having autumn and winter but no spring and summer, and a situation would arise in which the functions of birth and growth are muffled by the qi of death and extinction. Naturally, all kinds of diseases would arise from such a situation. At the same time it is without question that if there was only rising and no descending momentum within the body there would be disease.

From Yu Chang, The Statutes of Medicine (Yimen Falü), 1658:

Both the zang and the fu organ networks depend primarily on the spleen and the stomach. All food we eat enters the stomach and is then transported by the spleen, just like the dirt on earth [is distributed by wind and water to nourish all life forms]. It should be pointed out, however, that the spleen/stomach's capability of transforming the food is actually dependent on the two essential qualities of fire and water. The spleen and stomach cannot do this by themselves. When fire is in a state of excess, the spleen and stomach will be dry; when water is in a state of excess, the spleen and stomach will be damp. Either situation will cause the hundred diseases to arise.

From Yang Jizhou, The Great Compendium of Acupuncture and Moxibustion (Zhenjiu Dacheng), ca. 1590; listed in the spleen channel section as a quote from an older Daoist source, The Original Classic of Guiding the Breath (Daoyin Benjing) :

The spleen is situated at the center of the five organ networks. Therefore, it is assigned to no particular season but flourishes during all four seasons. It contains and fosters the five flavors, it brings about the five mental faculties, and it moves the four extremities and the one hundred marrows.

As soon as there is irregular intake of food and drink or overexertion of any kind, the spleen qi will be harmed. As soon as the spleen and stomach suffer damage, food and drink stagnate and do not transform: the mouth loses its ability to distinguish flavors, the extremities feel limp and tired, discomfort and distention is felt in the stomach and abdominal regions, symptoms of vomiting and diarrhea appear, and there may be dysentery or a host of other symptoms which have been specified in the Neijing and other books, and which can be looked up there.

If we therefore force ourselves to eat when we are not hungry, the spleen will suffer. If we force ourselves to drink when we are not thirsty, the stomach will bloat. If we eat beyond capacity, the vessels in which the qi circulates will become obstructed, and the body's center (stomach region) will become jammed and shut off. If we eat too little, on the other hand, the body will become emaciated, the stomach will grow anxious, and our thoughts will become unsteady. If we eat contaminated food, the heart's ability to differentiate will become blurred, and we will grow more and more restless. If we eat things that we should not eat, the four great upheavals will occur and bring along disease. None of these types of behavior represents the way of good health.

Therefore, it is most important to consume our food at the appropriate time, to drink our fluids in regular intervals, and to avoid both overeating and hunger pains. If we eat and drink according to these simple guidelines, then not only the spleen/stomach network itself will remain unspoiled and function perfectly, but also the five zang and the six fu organ networks will all be in a harmonious state of health.

After food and drink enter the mouth, they pass through the epigastric region into the stomach. From the stomach, the immaterial flavors contained in the food penetrate the five organs, whereas the material components enter the small intestine where they are further transformed. When they reach the lower opening of the small intestine, the first stage of the process of separating clear and murky materials occurs. Murky materials are the waste, to be passed on to the large intestine. The clear materials are the source of all bodily fluids; they enter the bladder which is called the store house of fluids. In the bladder, once again a separation of pure and murky materials takes place. The murky debris goes into the urine to be excreted, while the clear material enters the gallbladder. The gallbladder, finally, guides this purified fluid essence to the spleen which dispenses it to the five organ networks; they, in turn, utilize it to produce digestive saliva, nourishing saliva, nasal discharge, tears, and sweat. The flavors, meanwhile, penetrate the five organs and transform into the five types of essential dew, which return to the spleen where they are transformed into blood. In the form of nourishing blood, finally, they are returned to the organs.

The Classic states: "When the spleen is healthy it can generate all living things. If it becomes depleted, it can bring about the hundred diseases." The ancient poet, politician, and medical scholar Su Dongpo (1037-1101) used to harmonize the spleen by moderating food intake, even when there was enough money to eat lots. Therefore, I wish to extend the following advice to people who are in the habit of throwing lavish banquets: derive happiness from internal peace; always leave room in your stomach, so you can nourish your qi; and spend less if you wish to increase your material wealth.

The healthy person maintains the inside, while the unhealthy person maintains the outside. The person who maintains the inside pacifies his/her zang and fu organ networks, and thus causes the blood in the vessels to flow smoothly and uninhibited. The person who maintains the outside indulges in dazzling flavors and luxuriant culinary delights; albeit at first glance the body of such a person may appear strong and sturdy, a fierce verminous qi is corroding the zang and fu organs inside.

The stomach is in charge of receiving food and drink via the mouth and esophagus, containing them, and finally fermenting them. The stomach is therefore called the "sea of grain and water." After "grinding and fermenting" the incoming materials part of the essence distilled from food is passed on to the spleen, while the rest is passed on downwards to the small intestine. If the stomach fails to receive and ferment properly, the supply of postnatal qi to the other organ networks will be disturbed. Master Hua's Classic of the Central Viscera states: "If the stomach qi is strong, all of the five zang and the six fu networks will be strong."

The spleen is in charge of the transformation and distribution of food essence and fluids, as well as the transformation of pathological dampness. A healthy spleen will facilitate the optimal absorption and distribution of essence. Consequently, the entire body will be provided with the nutrients that are essential for survival. It is for this reason that the spleen has been labeled the postnatal root of life. If there is proper absorption and transformation of food essence, the food will turn into refined essence rather than into "damp" slush stagnating in the digestive tract. Conversely, the presence of dampness in the system will severely hamper the transformative actions of the spleen.

Part of the spleen's transporting function, moreover, is to move fluids upwards to the lung, from where they are "sprinkled" over the entire body to ensure proper moisturization. If this basic metabolism of fluids can function undisturbed, no buildup of pathological dampness will occur within the system.

The crucial transporting function of the spleen is entirely based on its action of "raising the pure (essence)." This means that in its physiological state the spleen qi exhibits a rising momentum. If the spleen qi rises, a "transporting" affect will ensue.

On the other hand, the equally important action of passing on of the dregs-and the continued differentiation of pure and turbid fluids-are a result of the stomach's downward momentum, generally referred to as "descending the turbid." Fluid differentiation and absorption is achieved cooperatively by the small intestine, the triple warmer, and the bladder, but these aspects of fluid metabolism are often attributed, simply, to the descending function of the stomach.

The influential Treatise on the Spleen and Stomach (Pi Wei Lun), written by the Yuan Dynasty medical authority Li Dongyuan, strongly underscores the rising function of the spleen. To clarify his point, Li refers to the workings of nature. He reminds his readers that the human body is a miniature replica of the surrounding macrocosm. All phenomena on earth, the Treatise points out, are produced by the intercourse of ascending earthly and descending heavenly qi. The upward momentum of the essence qi, propelled by the spleen, can be compared to the clear yang of nature which ascends toward heaven until it congeals into clouds in the sky. The ethereal part of this essence (the yang within yang) purifies and nourishes lung qi, thus maintaining an atmosphere of moistness, freshness, and clarity in the upper burner (which affects the sensory orifices of the ears, eyes, mouth, and nose). The denser portion of this ascending yang substance (the yin within yang) moistens the skin, strengthens the pores, and gives firmness to the limbs. And just as the turbid yin in nature condenses below to form earth, the Treatise goes on to explain, the clear essence of the turbid yin derived from food (the yang within yin) "turns red" and transforms into blood, thus nourishing the body, while the dregs and superfluous fluids are excreted. The turbid part of the turbid (the yin within yin), finally, forms the material basis for the bone marrow.

The Qing Dynasty essay collection, Spontaneous Thoughts Inspired by Reading the Medical Classics (Duyi Suibi), summarizes this pivotal role of the spleen/stomach by drawing a Taiji (yin-yang symbol) of bodily waxing and waning: "The heart and the lung are yang; as they follow the downward impulse of stomach qi and descend on the right, they transform into yin. The liver and the kidney are yin; as they follow the upward impulse of spleen qi and ascend on the left, they transform into yang."

The hollow stomach is in charge of "fermenting and ripening" incoming food. The character wei  (stomach) reflects the stomach's likeness to a high altitude field. Since fields in higher locations are closer to the sun and their moisture can easily drain downwards, their earth has a tendency to get dry, earning it the designation "yang earth." As the yang earth of the body, the stomach is known to easily become dry.

The spleen, among other things, is in charge of transforming dampness. The character pi  (spleen) reflects the spleen's likeness to a low-altitude field. Like the earth at the bottom of a valley, the spleen has a tendency to become damp, and is thus known as "yin earth."

The ideal milieu for their functioning is slight moistness for the stomach and near dryness for the spleen; that is the exact opposite of their natural tendencies, so the spleen and stomach must rely on each other to achieve a state of balance. Otherwise, the drying action of the stomach may fail to control spleen damp, and signs of stagnant water accumulation in the system will arise. Or the moistening quality of the spleen may fail to nourish the dry stomach, and symptoms of thirst, voracious appetite, or other signs of stomach heat will appear.

Although it is primarily the lung which governs bodily qi, and primarily the heart which governs blood, the spleen is the physical earth center which is the source of both the body's qi and blood. Both of these vital substances are considered to be transformations of food essence.

Qi does not only move body essences, but it also holds them in place. The fact that the blood circulates in the vessels without leaving its proper path is particularly attributed to the restraining function of spleen qi. The Classic of Difficulties (Nanjing) simply states: "The spleen contains the blood [pi tong xue]" This function of the spleen [associated with the earth element or phase] is evocative of the characteristics of earth: just as the rivers and streams are contained by an earthen bed, the body's blood is contained in the channels.

The absorbing and transporting function of the spleen/stomach is directly reflected in the development of a person's flesh and muscles. Strong and well developed arms and legs are therefore considered to be an important indicator for good spleen function. Weak, cold, painful, obese, or malformed arms and legs are a primary sign of spleen weakness.

The condition of the spleen manifests in the flesh of the mouth-the lips. Bright red lips, for instance, may indicate damp heat in the stomach. Chronic gum bleeding or structural changes of the gums may arise from spleen deficiency, while symptoms of severe dryness in the mouth, gum swelling, tooth aches, or severe hemorrhaging may be the result of a stomach excess (heat, dryness) condition. Structural pathologies in the oral cavity (including tongue shape and tongue coating) and unusual taste sensations in the mouth (or lack thereof) are almost always indicative of spleen/stomach disturbances.

The mental processes of thinking and remembering are considered to be part of the physiological activity of the spleen. A person with a poor digestive system usually cannot think clearly. This is because clear yang energy fails to rise up to the heart and brain, or because of accumulating dampness clouding the orifices. As always, this relationship also works the other way around: if a person thinks or worries too much, this can easily lead to digestive symptoms such as poor appetite, diarrhea, or constipation.

The Spleen/Stomach Is Unable to Absorb, Transform, and Transport: If stomach qi becomes injured, the stomach loses its ability to contain food, and the person will exhibit symptoms of aversion to food or drink, nausea and vomiting, hiccuping, or frequent belching. If the spleen loses its ability to transform and transport the essence of food, abdominal distention, loose stools or diarrhea, fatigue, or emaciation may occur. Also, if the spleen loses its ability to transport fluids and transform dampness, internal dampness and phlegm will accumulate, potentially manifesting in a variety of phlegm disorders, diarrhea, or edema.

The Balance Between Raising the Clear and Descending the Turbid is Disturbed: If the stomach's turbid substances do not descend, but push upwards instead, there will be symptoms of distention, vomiting, hiccuping, or belching of foul gases or sour liquids. If "the clear" cannot be properly raised upwards by the spleen, typical symptoms that may result are diarrhea, prolapse of the stomach, prolapse of the anus, or prolapse of the uterus/vagina. Collected Sayings by Dr. Wu (Wu Yi Hui Jiang) pointed out: "Among the many therapeutic approaches to spleen and stomach disorders, none is superior to harmonizing the dynamics of raising and descending."

Imbalance of Dryness and Dampness: If dampness hampers the free unfolding of spleen yang and thus the spleen's transporting ability, the stomach function will immediately be affected and symptoms of poor appetite or nausea will result. On the other hand, if there is excessive heat and dryness present in the stomach, this condition will in turn influence the function of the spleen: fluids will be scorched, resulting in constipation; or the spleen yang may collapse downward, causing symptoms of fatigue, constant sleepiness, frail extremities, diarrhea, and a slow pulse.

Stomach Disorder Influencing the Six Fu Organs: If there is dry heat in the stomach, it scorches the body's fluids; as a result, there will be constipation, and the transporting function of the large intestine will become severely inhibited. Damp heat in the spleen/stomach "steaming" the neighboring gallbladder can cause the bile to overflow and produce jaundice. Downpouring of damp heat from the spleen/stomach can have a detrimental effect on the triple warmer, the small intestine, and the bladder, and thus cause symptoms of dark and burning urination or dribbling urinary block. In the stomach itself, dry heat or food stagnation usually cause a loss of descending action, manifesting as epigastric stuffiness, vomiting, belching, acid regurgitation, abdominal distention, or constipation.

The Spleen Cannot Contain the Blood within the Vessels: If spleen qi decreases in strength, a loss of the spleen's function of containing the blood within the vessels may result. Various types of bleeding are thus sometimes associated with a deficiency of spleen qi, particularly recurrent hematomas, certain types of purpura, and prolonged menstrual bleeding. Since spleen-related hemorrhaging is always caused by a deficiency syndrome and usually involves slow leakage of pale blood, it should not be confused with the acute loss of profuse amounts of dark red blood caused by blood heat.

Unbalanced Mental Activity Harming the Spleen: If a person is involved in excessive worrying, thinking in pensive circles that lead nowhere, or simply has a mental focus that is too narrow or too intense, spleen symptoms such as loss of appetite, general exhaustion, or inhibited qi flow (causing insomnia, sleepiness, or lack of vision and mental clarity) may gradually manifest.

Mental and Physical Exhaustion Taking Their Toll on the Spleen: Ancient Chinese texts place particular emphasis on the fact that any exertion beyond one's individual limits will result in injury to the qi of the spleen/stomach. If a person is not allowed to recover from extreme exhaustion, there may be permanent weakness and fatigue, shallow breathing and a decreased desire to talk, heat sensations and spontaneous sweating, or asthmatic breathing that comes on with even slight physical exertion. In Neijing terms: "Exertion fritters away the qi."

The Spleen Is Unable to Govern the Flesh and the Muscles: Prolonged sitting or lying down is said to harm the spleen, and thus cause atrophy of the muscles. Since the spleen governs the flesh layer, all disorders such as a heavy and sore body, slow healing wounds, bed sores, emaciated arms and legs, the weak extremities of the chronically bed-ridden patient, and certain types of paralysis are results of spleen injury.

Spleen Disorder Affecting Changes in Appetite and Taste Sensation: A poor appetite, the feeling that "everything tastes like nothing," a voracious appetite, sugar cravings, or other pathological changes in appetite or taste sensation usually involve the spleen/stomach network. As the respective chapter in the historic reference work, An Illustrated Encyclopedia (Tushu Bian), explains: "Poor appetite is a sign of acute food stagnation or injury to the spleen/stomach. If the patient is hungry, but cannot get much of the food down, this is a sign of cold pathogens in the spleen. If a person craves sweets, this is a sign of spleen deficiency."

Tonify the spleen (with bland/sweet flavors) (bu pi; gan dan shi pi): dioscorea (shanyao), hoelen (fuling), lotus seed (lianzi), euryale (qianshi), coix (yiyiren), dolichos (biandou).

Build the center and uplift qi (jian zhong yi qi): codonopsis (dangshen), atractylodes (baizhu), astragalus (huangqi), jujube (dazao).

Warm the spleen (wen pi): dry ginger (ganjiang), evodia (wuzhuyu), black pepper (hujiao), zanthoxylum (shujiao).

Move the spleen (yun pi): red atractylodes (cangzhu), magnolia bark (houpo), cardamon (sharen), amomum (baidoukou).

Harmonize the center and regulate qi (li qi): citrus (chenpi), saussurea (muxiang), agastache (huoxiang), perilla stalk (sugeng), clove (dingxiang), galanga (gaoliangjiang).

Emolliate acute central distress (huan ji): licorice (gancao), jujube (dazao), honey (fengmi).

Raise central yang and lift collapse (sheng yang ju xian): cimicifuga (shengma), pueraria (gegen), astragalus (huangqi).

Dry damp (zao shi): red atractylodes (cangzhu), tsao-kuo (caoguo), cardamon (sharen), pinellia (banxia).

Transform phlegm (hua tan): citrus (chenpi), pinellia (banxia), bamboo skin (zhuru), bamboo resin (tianzhuhuang), bamboo sap (zhuli), sinapis (baijiezi), arisaema (tiannanxing).

Percolate damp (shen shi): hoelen (fuling), coix (yiyiren).

Disinhibit damp (li shi): polyporus (zhuling), alisma (zexie), akebia (mutong), capillaris (yinchen), polygonum (bianxu).

Drive out water rheum (zhu yin): zanthoxylum seed (jiaomu), atractylodes (baizhu), euphorbia (daji), daphne (yuanhua), kan-sui (gansui), phytolacca (shanglu).

Nourish stomach yin (yang wei yin): ophiopogon (maimendong), yu-chu (yuzhu), trichosanthes root (tianhuafen), dendrobium (shihu).

Clear stomach heat (qing wei re): gypsum (shigao), coptis (huanglian).

Purge stomach fire (xie wei huo): rhubarb (dahuang), mirabilitum (mangxiao).

Dissolve food accumulation (xiao dao): crataegus (shanzha), shen-chu (shenqu), malt (maiya), gallus (jineijin), chih-ko (zhike), raphanus (laifuzi).

Harmonize the stomach and descend rebellious qi (he wei jiang ni): fresh ginger (shengjiang), pinellia (banxia), clove (dingxiang), agastache (huoxiang), hematite (daizheshi).

Control acid (zhi suan): evodia (wuzhuyu), coptis (huanglian), cardamon (sharen), fritillaria (zhe beimu), cuttlefish bone (wuzegu), calcined oyster shell (duan muli).

Just as the earth assumes the position of centeredness, balance, and harmony in nature, the spleen/stomach network is the body's center of balance. All up and down movements pivot around it, and both damp and dry qualities come together here to form a physiologically beneficial alliance. As the main text of the fever school, Wenbing Tiaobian, points out: "The spleen should be treated like the beam of a scale: if it is not in horizontal balance, it will not be at peace." Treating the spleen/stomach also requires the use of substances that are harmoniously balanced. Foods and herbs that are overly hot or cold or dry or moistening should be avoided.

As a general rule, spleen disorders are usually of a deficient nature, requiring the tonification of central qi and the stimulation of the ascending movement of clear yang qi. Stomach disorders, though they may be based on deficient functions, usually involve excess or accumulation problems; accumulation needs to be dissolved and guided out.

Since the functioning of both the spleen and the stomach are closely tied to their respective directional momentum, proper qi movement needs to be restored in case of erratic movement. If the upwardly mobile spleen yang collapses downward (diarrhea, organ prolapse, etc.), it should be lifted by employing measures that tonify the spleen and boost central qi. If the stomach's descending motion is upset, as is the case with rebellious stomach qi (nausea, vomiting, etc.), the situation should be rectified by harmonizing the stomach and descending the rebellious qi.

Herbs that eliminate pathological dampness are common spleen therapies, including bitter herbs that dry damp, bland herbs that percolate damp, and spicy herbs that break down and eliminate phlegm and other types of pathological liquid. The stomach is often treated with substances that nourish and protect its physiological fluids: sweet and cold herbs that moisten dryness; salty and cold herbs that clear stomach heat; and herbs that protect its yin by clearing stomach heat, cleansing stomach fire, or in severe cases, effecting emetic or purgative action.

As the principal flavor of harmony, sweet has a primary affinity to the earth network. Therefore, if the spleen is in acute distress, sweet flavors can harmonize the spleen and be beneficial to the production of central qi. As the Neijing points out: "Sweet generates the spleen." If sweet foods are used excessively, however, they will produce phlegm, obstruct transformation, and harm the flesh layer that is associated with the spleen. Swelling, bloating, and obesity will result. Again, this fundamental principle has been recorded by the Neijing, stating that "sweet harms the flesh," and "if the disease is in the flesh layer, the patient should abstain from the excessive consumption of sweet flavors."

When treating spleen/stomach disorders, the system's relationship to other organ networks needs to be taken into consideration. Particularly the liver's overbearing influence needs to be corrected if it is the original cause for the spleen's distress. Spleen tonics are therefore often accompanied by herbs that smooth and emolliate the liver.

SPLEEN QI DEFICIENCY (pi qi xu): primary symptoms include decreased appetite; sallow complexion; fatigue; shallow breathing or shortness of breath; little desire to talk; epigastric and/or abdominal bloating (especially after eating); loose or unformed bowel movements. Secondary symptoms may include weak or emaciated extremities; edematous extremities; inhibited urination; decreased amount of (pale colored) menstrual flow. The tongue typically manifests with a pale body, toothmarks, and a thin white coating; the pulse tends to be weak and slow.

Representative Herbs: codonopsis (dangshen), astragalus (huangqi), atractylodes (baizhu), hoelen (fuling), dioscorea (shanyao), lotus seed (lianzi), coix (yiyiren), dolichos (biandou), jujube (dazao); citrus (chenpi), shen-chu (shenqu).

Representative Formulas: Four Major Herbs Combination (Si Junzi Tang); Six Major Herbs Combination (Liu Junzi Tang).

DOWNWARD COLLAPSE OF SPLEEN QI (pi qi xia xian): primary symptoms include weak voice; shortness of breath; fatigue; bloating sensation right after eating; prolapsing sensation in stomach and abdomen (wan fu zhong duo); (bianyi pinshuo); or possibly prolapse of anus due to chronic diarrhea; or prolapse of stomach or uterus. Secondary symptoms may include dizziness; unclear sensory perception (especially blurry vision); poor appetite; spontaneous sweating; mental and physical fatigue; diarrhea. The tongue typically presents with a pale body and a thin white coating; the pulse tends to be weak and empty.

Representative Herbs: astragalus (huangqi), codonopsis (dangshen), atractylodes (baizhu), dioscorea (shanyao), dolichos (biandou), cimicifuga (shengma), pueraria (gegen); bupleurum (chaihu), citrus (chenpi).

Representative Formula: Ginseng and Astragalus Combination (Buzhong Yiqi Tang).

STOMACH YIN DEFICIENCY (wei yin xu): primary symptoms include dry lips; frequent thirst sensation; dry throat; sticky sensation in the mouth; poor appetite; sensation of emptiness, stuckness, or pain in epigastric region. Secondary symptoms may include hunger sensation without desire for food; constipation; restlessness; sensations of surging heat. The tongue typically presents with a red body and a mirror surface without coating, or with a red body and little coating, or with a dry tongue and little moisture; the pulse tends to be fine and rapid.

Representative Herbs: glehnia (bei shashen), ophiopogon (maimendong), yu-chu (yuzhu), dendrobium (shihu), raw rehmannia (sheng dihuang), trichosanthes root (tianhuafen), Asian pear juice (li zhi), sugar cane juice (ganzhe zhi); bamboo skin (zhuru).

Representative Formulas: Glehnia and Ophiopogon Formula (Shashen Maidong Yin), Boost the Stomach Decoction (Yiwei Tang).

SPLEEN YANG DEFICIENCY (pi yang xu): primary symptoms are spleen qi deficiency symptoms with an emphasis on cold signs, such as abdominal pain that improves with the application of heat and pressure; cold extremities; poor appetite; abdominal bloating; loose or unformed stools. Secondary symptoms include decreased taste sensation; little desire to drink; edematous extremities; inhibited urination; increased amounts of clear vaginal discharge. The tongue typically presents with a pale and tender body and a white and slippery coating; the pulse tends to be deep and fine, or deep and slow.

Representative Herbs: dry ginger (ganjiang), aconite (fuzi), evodia (wuzhuyu), zanthoxylum (chuanjiao), clove (dingxiang), atractylodes (baizhu), codonopsis (dangshen).

Representative Formulas: Ginseng and Ginger Combination (Lizhong Tang), Fill the Spleen Formula; Magnolia and Atractylodes Combination (Shipi Yin).

COLD DAMP OBSTRUCTING THE SPLEEN (han shi kun pi): primary symptoms are a general sense of heaviness in the body and/or the head; discomfort or bloating in the abdomen or epigastric region; reduced taste sensation; little or no thirst; abdominal pain; unformed stools or diarrhea. Secondary symptoms include no appetite; nausea and vomiting; sticky sensation in mouth; puffy face; edematous extremities; bags under the eyes; increased vaginal discharge. The tongue is typically fat and has a greasy white coating; the pulse tends to be soft and moderate.

Representative Herbs: red atractylodes (cangzhu), atractylodes (baizhu), hoelen (fuling), magnolia bark (houpo), citrus (chenpi), pinellia (banxia), tsao-kuo (caoguo), agastache (huoxiang), (peilan), perilla stalk ( zi sugeng).

Representative Formulas: Magnolia and Citrus Combination (Pingwei San); Magnolia and Hoelen Combination (Wei Ling Tang).

DAMP HEAT IMPLICATING THE SPLEEN (shi re yun pi): primary symptoms are stuffy sensation in the subcostal and epigastric regions; abdominal bloating; poor appetite; dry and sticky sensation in mouth; aversion to greasy foods; nausea and vomiting; general sensation of heaviness; jaundiced eyes and face. Secondary symptoms may be body itch; fever; dark and scanty urination; obstructed bowel movements. The tongue typically presents with a greasy and yellow coating; the pulse tends to be soft and rapid.

Representative Herbs: capillaris (yinchen), bamboo skin (zhuru), red atractylodes (cangzhu), atractylodes (baizhu), hoelen (fuling), polyporus (zhuling), alisma (zexie), chih-shih (zhishi).

Representative Formulas: Capillaris and Hoelen Five Formula (Yinchen Wuling San); Capillaris and Hoelen Four Formula (Yinchen Siling San).

THE SPLEEN CANNOT CONTAIN THE BLOOD WITHIN THE VESSELS (pi bu tong xue): primary symptoms are general signs of spleen qi deficiency, such as pale face and tendency towards diarrhea, accompanied by signs of bleeding, such as blood in the stool, nose bleed, gum bleeding, subcutaneous bleeding (purpura), increased amounts of menstrual bleeding or continuous spotting. Secondary symptoms may include other spleen deficiency symptoms, such as decreased appetite; fatigue, bloating after eating; shallow breathing or shortness of breath; cold extremities; skinny constitution. The tongue typically presents with a pale body and a white coating; the pulse tends to be soft, fine, and weak.

Representative Herbs: codonopsis (dangshen), astragalus (huangqi), atractylodes (baizhu), tang-kuei (danggui), dioscorea (shanyao), lotus seed (lianzi), roasted ginger (paojiang), longan (longyanrou), baked licorice (zhi gancao).

Representative Formula: Ginseng and Longan Combination (Guipi Tang).


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