Course A: Basic Theories of Traditional Chinese Medicine

Chapter 1 The Theory of Yin-Yang and Five Elements Section 1. The Theory of Yin-Yang 1. The Concept of the Theory of Yin-Yang 2. Basic Contents of the Theory of Yin-yang 3. Application of the theory of Yin-Yang in Traditional Chinese Medicine Section 2. The theory of the Five Elements 1. Basic Concepts of the Five Elements 2. Basic Contents of the theory of the Five Elements 3. Application of the Theory of the Five Elements in Traditional Chinese Medicine Summery/General Description Chapter 1. The Theory of Yin-Yang and Five Elements Section 1. The Theory of Yin-Yang 1. The concept of the theory of Yin-Yang What is Yin-Yang? The terms of Yin and Yang first appeared in Yi Jing" (the Book of Changes in Zhou Dynasty). At its origin, the terms were used to designate the two slopes of a mountain. The sunny side was Yang and the shady side was Yin. Later, their meaning broadened to include all opposites. Yin and Yang then were used to denote cold or warm weather; downward or upward direction; left or right; exterior or interior; and quiescence or dynamic. All natural events and states of being are rooted in Yin and Yang, and can be analyzed by the theory of Yin-Yang. The theory of Yin-Yang, however, does not itself refer to any concrete objective phenomena. It is a theoretical method for observing and analyzing phenomena. Generally speaking, Yin and Yang are a philosophical conceptualization, a means to generalize the two opposite principles that may be observed in all related phenomena within the natural world. They may represent two separate phenomena with opposing natures, as well as different and opposite aspects within the same phenomenon. Thus the ancient Chinese people came to understand that all aspects of the natural world could be seen as having a dual aspect, for example, day and night, brightness and darkness, movement and stillness, heat and cold, etc. It was said: "Water and fire are symbols of Yin and Yang". This means that water and fire represent the two primary opposite aspects of a contradiction. Based on the properties of water and fire, everything in the nature may be classified as Yin and Yang. Those with the basic properties of fire, such as heat, movement, brightness, upward and outward direction, excitement, and potency pertain to Yang; while those with the basic properties of water, such as coldness, stillness, dimness, downward and inward direction, inhibition, and weakness pertain to Yin. Accordingly, within the field of medicine different parts of the body are classified as either Yin or Yang. For example, the upper and exterior parts of the body belong to Yang and the lower and interior parts to Yin; the hands belong to Yang; while the feet to Yin; the five Zang organs pertain to Yin; the six Fu organs to Yang. The Yin-Yang nature of a phenomenon is not absolute but relative. This relativity is reflected in two ways. On one hand, under certain conditions Yin may change into Yang and vice versa (the inter-transforming nature of Yin and Yang), and on the other, any phenomenon may be infinitely divided into its Yin and Yang aspects, reflecting its own inner Yin-Yang relationship. Day, for example, is Yang, while night is Yin. However, each can be further classified as follows: morning is Yang within Yang, afternoon is Yin within Yang, the first half of the night Yin within

Yin, and the second half of the night Yang with Yin. This differentiation of the natural world into its opposite parts can be carried out infinitely. Therefore it can be seen that Yin and Yang are at the same time opposite in nature and yet interdependent. They both oppose and complement each other, and exist within all natural phenomena. Traditional Chinese medicine applies the Yin-Yang principles of interconnection and continuous transformation to the human body to explain its physiology and pathology and to guide clinical diagnosis and treatment. 2. Basic contents of the theory of Yin-Yang 2.1. The opposition and interaction of Yin-Yang The theory of Yin-Yang holds that everything in nature has two opposite aspects which are generalized as Yin and Yang, such as upper and lower, left and right, heaven and earth, quiescence and dynamism, entry and exit, ascending and descending, day and night, bright and dark, cold and heat, water and fire, etc. Yin and Yang are opposites yet form a unity. The opposition of Yin and Yang is mainly reflected in their interaction and mutual wax and wane through which their unity or dynamic balance is reached, being called "equilibrium of Yin and Yang". For example, in spring, summer, autumn and winter, the weather varies from warm, hot and cool to freezing cold. Warm and hot weather in spring and summer results from a rise of Yang Qi which inhibits the cold of autumn and winter. Cool and cold weather in autumn and winter is due to the rise of Yin Qi which inhibits the heat of spring and summer. Such is the result of the interaction as well as mutual wax and wane in nature. The process of interaction between Yin and Yang is also the process of their mutual wax and wane. Normal human life is the result of such interaction between Yin and Yang, which helps maintain a kind of dynamic equilibrium. Only in this dynamic equilibrium can development and change occur, and the natural world perpetually flourishes. 2.2. The interdependence between Yin and Yang "Without Yang there would be no generation of Yin, without Yin there would be no production of Yang". Yin and Yang oppose each other and yet, at the same time, also have a mutually dependent relationship. Neither can exist in isolation: without Yin there can be no Yang, without Yang no Yin. Without cold there would be no heat. Both Yin and Yang are the prerequisite for the existence of the other, and this relationship is known as the interdependence of Yin and Yang. When the concept of the interdependence is applied to the physiology of the human body, Yin corresponds to nutrient substances, and Yang to functional activities. The nutrient substances remain in the interior, therefore, "Yin remains inside"; while the function activities manifest on the exterior, so "Yang remains outside." The Yang on the exterior is the manifestation of the substantial movement in the interior, so it is know as "the envoy of Yin". The Yin in the interior is the material basis for functional activities and is therefore called the "backing of Yang". 2.3. Dynamic equilibrium (inter-consumption-support) of Yin and Yang Yin and Yang within an object are not fixed, but instead are in a state of constant motion and ever changing. Under normal conditions, the interactive and mutual wax and wane relationship between Yin and Yang is in a state of relative equilibrium rather than in a state of absolute stillness and balance. The equilibrium what stems from the mutual wax and wane of Yin and Yang, conforms to the law that motion, and growth and decline are absolute, while quiescence and balance are relative. In other words, the relative stillness involves in the absolute motion, or the absolute wax and

wane, while the absolute wax and wane exist in the relative balance. Everything grows and develops in the dynamic equilibrium between the absolute motion and the relative stillness, and between the absolute growth and development on one hand and the relative balance in the other. For example, in terms of physiological activity, the human body tends to excite during the day because Yang dominates at that time but tends to inhibit at night because Yin dominates then. Just as Yang starts to rise at midnight and peaks at noon, so do human physiological activities turn gradually from inhibition to excitation, this is the process known "waning of Yin and waxing of Yang". But from noon to evening, Yang gradually falls, while Yin grows, it follows that physiological activity gradually turns from excitation to inhibition. This process is known as " waning of Yang and waxing of Yin". Thus under normal physiological conditions, Yin and Yang do not reside peacefully in a unified object. They are in a dynamic state of mutual restriction in which they consume and support each other. This is known as the "harmony between Yin and Yang". We can never ignore the importance and necessity of the relative equilibrium of Yin and Yang though the growth and decline of Yin and Yang are absolute, and the equilibrium is relative, because it is the continuous growth and decline of Yin and Yang and the constant balancing of the two that promote the normal development of things and maintain the normal life activities. If there is only "waning of Yang and waxing of Yin," or "waning of Yin and waxing of Yang," a breakdown in the relative balance will occur, resulting in either the excess or the deficiency of Yin or Yang. In physiological terms, a state of morbidity occurs, just as Plain Questions" points out: " The excess of Yin leads to disorders of Yang, and the excess of Yang leads disorders of Yin." 2.4. Mutual transformation of Yin and Yang Under certain circumstances, either Yin or Yang may transform into its opposite, i.e. Yin may transform into Yang and Yang into Yin. The stage at which the transformation occurs is described as the "extreme". If the mutual wax and wane of Yin and Yang represents a process of quantitative change, then the mutual transformation of Yin and Yang denotes a qualitative change which is based on the quantitative change. The mutual transformation is ordinarily a slow conversion from one to the other, though abrupt transformation is also possible. The mutual transformation of Yin and Yang depends on certain factors. Plain Questions" says, "Yin in extreme will give rise to Yang, and Yang in extreme will give rise to Yin," and "Extreme cold may bring about heat, and extreme heat may induce cold." Extreme Yin cold may change to Yang heat under certain conditions and vice versa. The decisive factors are the conditions, without which such a transformation is impossible. Physiologically, the mutual conversion between excitation and inhibition is the same. During the courses of a disease, Yang may turn into Yin and Yin into Yang. For example, a sudden collapse of Yang may happen in some cases of persistent pyrexia that occurs in acute febrile diseases associated with virulent heat; this massive loss of Yang is manifested by subnormal body temperature, pallor, cold limbs and faint pulse. This condition exemplifies the change of a Yang syndrome to a Yin syndrome. If timely and appropriate measures are taken, warmth returns to the limbs and Yang is restored; a healthier complexion and pulse return and the condition turns for the better. Here is another example, obstruction of the stomach by cold fluid is a Yin syndrome, but due to certain factors the cold fluid turns to the pathogenic heat, thus the Yin syndrome becomes a Yang syndrome. In general, the transformation from Yin to Yang vice versa relies on certain conditions, otherwise the transformation is impossible. 3. Application of the theory of Yin-Yang in traditional Chinese medicine

In traditional Chinese medicine Yin and Yang is embodied in every aspect of the theoretical system. It is used to explain the tissues and structures, physiology and pathology of the human body, and to direct the clinical diagnosis and treatment. 3.1. Explaining the tissues and structure of the human body According to the theory of Yin and Yang, it is considered that there are opposite but unitive phenomena between rostral and caudal, inside and outside, exterior and interior, dorsal and ventral aspects of every tissue and structure of the human body. When speaking of Yin and Yang in the human body, the upper part is Yang, the lower part Yin; the exterior is Yang, the interior Yin; the back is Yang, the abdomen Yin; the lateral aspect of the extremities is Yang; the medial aspect Yin. When speaking of Yin and Yang of the internal organs in the body, the five Zang organs, i.e. heart, lung, liver, spleen and kidney are Yin, because their functions of preserving vital substance tend to be stable. The six Fu organs, i.e. the gallbladder, stomach, large intestine, small intestine, bladder and San Jiao (triple energizer), are Yang, because their functions of transmitting and digesting water and food tend to be active. The relationship between Yin and Yang also remains constant among the five Zang organs. The heart and lung are Yang, because of being higher, while the liver, spleen and kidney are Yin, because of being lower. To compare the heart and lung, the heart is Yang and the lung is Yin. When speaking of Yin and Yang of every organ, the function is Yang, the substance (or organ proper) Yin. When speaking of Yin and Yang of the meridians and collaterals, the meridians are divided into Yin meridians and Yang meridians. There are three Yang meridians of the hand and three Yin meridians of the hand, three Yang meridians of the foot and three Yin meridians of the foot. 3.2. Explaining the physiological activities TCM believes that the normal physiological activities of the human body result from the opposite, unitive and coordinate relations between Yang (function) and Yin (substance). Yin and Yang always maintain their dynamic equilibrium. It is known as "Yin is even and well while Yang is firm, hence a relative equilibrium is maintained, and the essence and spirit will be in normal state." Physiological functions are based on the substance. Without substance, including the vital essence, blood and body fluids, there would be no source for functions. But the metabolism of substance must depend on the performance of function. If Yin and Yang of the human body separate from each other and can not aid each other, life will come to an end. This is what is called, in TCM, " the divorce of Yin and Yang means the end of one's life." 3.3. Explaining the pathological changes In TCM, it is thought that the imbalance of Yin and Yang is one of the basic pathogeneses of a disease. For example, preponderance of Yang leads to the hyperfunction of the organism or the endogenous heat manifestations, while preponderance of Yin results in the hypofunction of the organism or the endogenous cold. Deficiency of Yin as the result of exhausted vital essence may lead to the endogenous heat. Yang in excess makes Yin suffer, while Yin in excess makes Yang suffer. In severe damage of Yang, Yin is involved; in severe damage of Yin, Yang is involved likewise, thus, both are damaged. A case of Yin nature (hypofunction) in its extreme may show Yang (hyperfunction) symptoms and signs, while a case of Yang nature (hyperfunction) in its extreme will give rise to Yin (hypofunction) symptoms and signs. 3.4. Serving as a guide to clinical diagnosis and treatment The root cause for the occurrence and development of diseases is the imbalance between Yin and Yang. For this reason, however complicated and changeable the clinical manifestations may be, with a good command of the principle of Yin-Yang, the key linking elements could be grasped and analyzed effectively. Generally speaking, the nature of any diseases does not exceed

the scope of analysis by Yin-Yang. Yin-Yang is the basis for the differentiation of syndromes by the eight principles, namely, Yin, Yang, interior, exterior, heat, cold, deficiency and excess. Exterior, heat and excess are Yang, whilst interior, cold and deficiency are Yin. In this way, complicated clinical situations can be simplified, and a correct diagnosis given. Since the root cause for the occurrence and development of disease is the imbalance of Yin and Yang, the basic principle in the treatment of traditional Chinese medicine is to adjust Yin and Yang, making "Yin stabilized and Yang well conserved" and restoring the harmony between them. Therefore, in acupuncture the essential technique of needling consists of striking a balance between Yin and Yang. Now it can be seen that the basic function of acupuncture needling is to adjust the Qi of Yin and Yang. In the clinical application of acupuncture, the theory of Yin-Yang is applied to determine not only the principles of treatment, but also the selection of points and the techniques of needling and moxibustion to be used. For instance, combining points from externally-internally related meridians, as well as combining Yuan-Primary and Luo-Connecting points, is used extensively in clinical practice, both of which are the methods of selecting points from related Yin and Yang meridians. In addition, Back-Shu and Front-Mu points are often selected to treat diseases of the Zang-Fu organs. The related Back-Shu points are mostly selected for diseases of the Zang organs, and the related Front-Mu points for those of the Fu organs. Alternatively, a combination of Back-Shu and Front-Mu points is applied to "select Front-Mu points for Yang diseases and Back-Shu points for Yin diseases," in order to adjust Yin and Yang in either excess or deficiency. Where acupuncture and moxibustion are used together, apply moxa to the upper part of the body first and the lower part second, and "insert needles deeply with retention for Yang diseases." From this view, it is apparent that in acupuncture and moxibustion therapy, the meridians, acupoints, and acupuncture-moxibustion techniques are all closely related to the theory of Yin and Yang, emphasizing the vital role that Yin and Yang play in both theory and practice. Section 2. The Theory of the Five Elements 1. Basic concepts of the theory of five elements The five elements refer to five categories in the natural world, namely wood, fire, earth, metal and water. The theory of the five elements was first formed in China at about the times of the Yin and Zhou dynasties (16th century-221 B. C.). Although the Chinese theory of the five elements and Greek theory of the four elements are different in history of formation, yet both of them belong to the earliest atomic theory in essence. At first, the Chinese only knew that the five kinds of substances (wood, fire, earth, metal and water) were indispensable things in the daily life of mankind, subsequently they made a generalization and deduction of the respective properties of the five kinds of substances and their relationship, so as to explain the whole material world. According to the theory wood, fire, earth, metal and water are the basic substances that constitute the material world. These substances are not only of the relations with generation and restriction but set in a state of constant motion and change. That is why it is know as the theory of the five elements or the doctrine of five evolutive phases. 2. Basic contents of the theory of the five elements 2.1.Characteristics of the five elements

In early times, the Chinese people recognized that wood, fire, earth, metal and water were the indispensable in their daily lives as well as having different natures. As said in A Collection of Ancient Works" , Food relies on water and fire. Production relies on metal and wood. Earth gives birth to everything. They are used by the people. The character of wood is to grow and flourish, that of fire is to be hot and flare up, that of earth is to give birth to all the other things, that of metal is to descend and to be clean, and that of water is to be cold and to flow downwards. 2.2.Categorization of things according to the five elements In light of the theory of five elements, traditional Chinese medicine has made a comprehensive comparison and study of all kinds of things and phenomena in nature as well as in the Zang-Fu organs, tissues, physiology and pathology of the human body, classified them respectively to one of the five elements, i.e., wood, fire, earth, metal and water, in accordance with their different properties, functions and forms, thus expounding the physiology, pathology of the human body and the correlation between man and his natural surrounding. The following is a table showing the classification of things according to the theory of the five elements. The Classification of things according to the theory of five elements

Table 1: Human Body Five elements wood fire earth metal water Five Zang organs liver heart spleen lung kidney Six Fuorgans gall bladder small intestine stomach large intestine bladder Five sense organs eye tongue mouth nose ear Five tissues tendon vessel muscle skin & hair bone Emotional activity anger joy over-thinking grief fear and fright

Table 2: Nature Five Environmental Growth & elements factor development Color Taste wood fire earth metal water wind heat dampness dryness cold germination growth green red sour bitter Season Orientation spring east summer south late middle summer winter north

transformation yellow sweet reaping storing white black

pungent autumn west salty

2.3. Mutual promotion and restriction, subjugation and reverse restriction relationships of the five elements Among the five elements, there exist the relations of promotion, restriction, subjugation and reverse restriction. Promotion implies promoting the growth. The order of promotion is as follows: wood promotes fire, fire promotes earth, earth promotes metal, metal promotes water, and water, in turn, promotes wood. As far as the relationship of generation of each of the five elements is concerned, it is composed of two aspects--promoting and being promoted. The element that promotes is called the mother, while the element that is promoted is called the child. Hence, the relation of promoting and being promoted among the five elements is also known as that of mother and child. Take fire for example, since fire produces earth, it is called the mother of earth; on the other hand it is produced by wood, so it is called the child of wood. Restriction (also known as "interacting" connotes bringing under control or restraint. So far as the relationship of restriction that the five elements possess is concerned, it works in the following order: wood restricts earth, earth water, water fire, fire mental, and metal wood. Each of the five elements has the chance of restricting and being restricted. Take fire for example, the element restricting fire is water, and element that is restricted by fire is metal. In view of the correlations among things, neither promotion nor restriction is dispensable. Without promotion, there would be no birth and development; without restriction, excessive growth would result in harm and damage. For instance, on one hand, fire promotes earth, and on the other, it restricts metal; while metal, in return, promotes water and restricts wood. Thus in promotion there resides restriction, and in restriction there exists promotion. They oppose each other and at the same time cooperate with each other, thus a relative balance is maintained between promotion and restriction, and the normal growth and development of things is ensured. Should one of the five elements be excessive or insufficient, there would appear the phenomena of abnormal restrictions, known as subjugation (also known as "overacting" ) and reverse restriction (also known as "counteracting"). By subjugation is meant that one element subdues the other when the latter is weak or when one element is extraordinarily excessive, it will subjugate its restricted element. It is the manifestation of abnormal coordination among things. For example, if wood is in excess and metal can not exercise normal restriction on it, then the excessive wood will subjugate earth in such a way that earth will become weaker; or on the other hand when the earth is insufficient wood will subjugate it even wood is not really excessive. Reverse restriction means preying upon others. That is, when any one of the five elements is in excess, the one originally restricting it will be restricted by it instead. That is why we call it reverse restriction. For, instance, the normal order of restriction is that metal restricts wood; but if wood is in excess or metal is insufficient, wood will restricts metal in the reverse direction. It is clear that the order of reverse restriction is just opposite to that of restriction and that reverse restriction is undoubtedly a very harmful one. 3. Application of the theory of five elements in traditional Chinese medicine In traditional Chinese medicine, the theory of five elements is mainly used to explain the physiology and pathology of the human body and to guide the clinical diagnosis and treatment. 3.1.Explaining the physiological functions of the Zang-Fu organs and their mutual relationships The promotion of the five elements can be used to expound the interdependent relations between the five Zang organs. For instance, the vital essence of the kidney (water) nourishes the

liver (wood), which is known as water generating wood. The liver (wood) stores blood to nourish the heart (fire), which is termed as wood generating fire. The heat of the heart (fire) warms the spleen (earth), which is called fire generating earth. The spleen (earth) transforms and distributes food essence to replenish the lung (metal), which is referred to as earth generating metal. The lung (metal) dredges the water passages to help the kidney (water), which is taken as metal generating water. The restriction of the five elements can be used to explain the inter-restraining relations between the five Zang organs. For example, the lung (metal) purifies and descends so as to restrain the exuberance of the liver (wood), which is known as metal restricting wood. The liver (wood) that functions well smoothes and regulates the stagnation of the spleen (earth) Qi, which is called as wood restricting earth. The function of the spleen (earth) plays in transforming nutrients and promoting water metabolism and may prevent the overflow of the water of the kidney (water), which is referred to as earth restricting water. The ascending of the kidney (water) can prevent the heart (fire) from hyperactivity, which is understood as water restricting fire. 3.2. Showing the pathological relationships between the Zang-Fu organs As it is well known, the theories of subjugation, reverse restriction, "illness of mother-organ involving child-organ", and "illness of child-organ involving mother-organ" in regard of the five elements are usually used to expound the pathological impacts between the five Zang organs. Take lung disease for example, if it results from the disorders of heart, that is regarded as "fire subjugating metal"; if it is caused by the disorders of liver (wood), that is referred to as "wood reversely restricting metal"; if it is developed from the disorders of spleen (earth), that is looked upon as "illness of mother-organ involving child-organ"; and if it is due to disorders of kidney (water), that is taken as "illness of child-organ involving mother-organ". 3.3. Application in diagnosis and treatment of diseases Because, in accordance with the categorization of things and phenomena to the five elements, the five Zang organs have specific connections with the five colors (green/blue, red, yellow, white and black,) the five voices (shouting, laughing, singing, crying and moaning), the five kinds of flavors (sour, bitter, sweet, acrid/pungent and salty) as well as the relevant pulse conditions, one, when diagnosing, should take the steps as: first, to generalize the materials obtained through the four diagnostic methods (inspection, auscultation & olfaction, inquiring and palpation), and then, to deduce what the disease is according to the theory of five elements. For example, a condition of a bluish face associated with the string-taut pulse may indicate liver disease; while the manifestations of red face, bitter taste in the mouth, and surging pulse may suggest the hyperactivity of heart fire. The patient whose spleen Qi is deficient might look bluish because of "wood having subjugated earth"; and the patient who has heart trouble might look dark-purplish because of "water having restricted fire", to mention but a few. In acupuncture and moxibustion treatment, there is a use of a type of specific point named as Five-Shu points which correspond to the five elements. The Jing-Well, Ying-Spring, ShuStream, Jing-River and He-Sea points of the Yin meridians correspond to wood, fire, earth, metal and water respectively, whilst those of the Yang meridians correspond to metal, water, wood, fire and earth respectively. Clinically they are selected for treatment according to the principle of "reinforcing the mother" and "reducing the child." In addition, it is common in clinical practice to determine the principle of treatment and selection of points according to the pathological influences among the Zang-Fu organs which follow the cycle of the five elements. For instance, in case of a disharmony between the liver and stomach, "wood overacting on earth," the principle of treatment should be to reinforce the earth and to restrain the wood and such points as Zhongwan (RN 12), Zusanli ( S 36) and Taichong ( Liv3) could be selected.

Summery/General descriptions The Concept of the Yin and Yang and the five elements represent the ancient naive Chinese materialism and dialectics, reflecting world outlook and methodology of the ancient Chinese people in understanding and explaining natural phenomena. The theory of Yin-Yang holds that the world is material and that this material world evolves constantly as the result of the mutual action of two opposing material forces. The theory of the five elements assumes that the world is made up of five basic elements: wood, fire, earth, metal and water. The existence of the material world depends on the mutual promotion and mutual restraint among the five elements. This concept had exerted a profound influence on the early Chinese materialistic philosophy and became the theoretical basis on the materialistic world outlook and methodology of natural science in ancient China. Early Chinese practitioners used the theory of Yin-Yang and the five elements to explain the physiological functions of and pathological changes in the human body, and to guide medical diagnosis and treatment. This theory constitutes an important part of the theoretical system of traditional Chinese medicine (TCM), very significant to its formation and development. However, the elements of materialism and dialectics contained in the theory of Yin-Yang and the five elements can never be on a par with modern scientific materialist dialectics. Therefore, in studying them, we must proceed from the views of dialectical and historical materialism to discard the superficial and preserve the essential, so as to make it better serve the needs in medical practice.