Chinese medicine theory
1. Yin and Yang and the Five Elements
--The Philosophic Concept
in the Theory of Chinese MedicineThe concepts of yin and yang and the five elements were thesimple materialism and spontaneous dialectical thought in ancientChina. It is believed that the material world engenders and develops by the promotion of yin and yang. The five objects: wood, fire, earth,metal and water, are the fundamental elements to form the world and
also are indispensable 'in the daily life of the human beings. These five kinds of objects possess the interpromoting and interrestraining relationship and stay in the constant motion and change. This viewpoint was extensively utilized in the ancient natural sciences, such as astronomy, calendrical science, agriculture, medicine, to explain all the phenomena of the nature.The utilization of the theories of yin and yang and the five elements in the medical field is able to explain the physiological functions and pathological conditions of the human body and guide the diagnosis and treatment and becomes an important component part in the theory of Chinese medicine.
I. I The Theory of Yin and Yang
The concept of yin and yang is the generalization of the two
opposite aspects in some related objects and phenomena in the
natural world. Not only it can represent the two opposite objects,but also it can represent the two opposite aspects existing within the interior of the same object.
All the objects in the universe include the two opposite aspects of yin and yang, such as day and night, fine and overcast, heat and cold, motion and tranquillity, etc.. Due to the motion and change of the two aspects of yin and yang, all the objects are formed and the development and change of the objects are promoted. Therefore it is said: "Yin and yang are the way of heaven and earth." In the theory and clinical practice of Chinese medicine, the basic viewpoints in the theory of yin and yang: the attribution of yin and yang, the divisibility of yin and yang, the interdependence
of yin and yang, the interrestraint of yin and yang, the mutual
transformation of yin and yang, are used widely to explain the
tissues, structure, physiological activities, pathological changes of the human body and to explain the prognosis of diseases as well as the pattern identification and treatment.
1) The attribution of yin and yang
All the objects can possess the attribution of yin and yang respectively. In Chinese medicine, in the explanation of the tissues and structure of the human body, the theory of yin and yang holds that the human body is an organic entirety and that all the tissues and structure are organically related and also can be ascribed to two aspects of yin and yang in opposition.
In the tissues and structure, the upper part of the body belongs to yang, the lower part of the body belongs to yin; the body surface belongs to yang, the interior of the body belongs to yin. In the body surface, the back belongs to yang, the abdomen belongs to yin;the lateral side belongs to yang, the medial side belongs to yin.In the zang-fu organs, the six fu organs belong to yang, while the five zang organs belong to yin.In the physiological activities, all those activities that can have the promotive and warming functions to the human body are often termed "yang", while those activities that can have the nourishing and moistening functions to the human body are termed "yin" in medicine. For example, qi belongs to yang, blood belongs to yin;the excitement belongs to yang, and the inhibition belongs to yin.
In the pattern identification and pulse phenomena, the exterior
syndrome, excessive syndrome and heat syndrome belong to yang,
while the interior syndrome, deficient syndrome and cold syndrome belong to yin. The floating pulse, rapid pulse and slippery pulse belong to yang, while the deep pulse, slow pulse and hesitant pulse belong to yin.
In the treatment of diseases, the theory of yin and yang can
usually guide to decide the basic principle for the treatment of the disease. For example, when the diseases are the excessive syndrome,the therapies should be "the reducing method". When the diseases are the deficient syndrome, the therapies should be "the tonifying method". The utilization of the theory, of yin and yang in the treatment of diseases not only can establish the principle of the treatment, but also can generalize the natures, tastes and functions of
the herbs as the basis for the clinical application of the herbs. For example, the cold, cool and moist herbs belong to yin, whereas the warm, hot, dry and fierce herbs belong to yang; those herbs that are sour, bitter and salty in taste are yin, while those herbs that are pungent, sweet and bland in taste are yang. Those herbs that possess the the astringent and descending abilities belong to yin, and those herbs that have the ascending and dispersing abilities belong to yang.
2) The divisibility of yin and yang
Chinese medicine holds that any object can be divided into
two attributes of yin and yang, and the interior of one object
can again be divided into two aspects in opposition, i.e. there are yin and yang within yin, while there are yin and yang within yang.Furthermore, any aspect of yin or yang in one object can be constantly divided into yin and yang ad infinitum.In the tissues and structure of the human body, the five zang organs belong to yin, while the six fu organs belong to yang. Yin and yang can be further divided in the five zang organs. For example, the heart and lung are located in the upper part and belong to yang,while the liver, spleen and kidney are located in the lower part and belong to yin. In terms of each organ, yin and yang can be further divided. For example, there are heart yin and heart yang in the heart, there are liver yin and liver yang in the liver, and there
are kidney yin and kidney yang in the kidney, etc.
3) The interdependence of yin and yang
The viewpoint of the interdependence in yin and yang is to ex-
plain that yin and yang are mutually indispensable and engendering.Yin exists by virtue of yang, while yang exists by virtue of yin, and any aspect cannot separate itself from the other and exist independently.
In the physiological functions of the human body, the relation-
ship between qi and blood is exactly the example of the interdependence of yin and yang. In terms of the attribution of yin and yang,qi is yang and blood is yin. Both qi and blood are the fundamental materials to form the human body. Blood is produced by depending upon qi to transport and transform the essence of water and grain,therefore it is said: "Qi is able to produce blood." The circulation of blood relies on the warming and transporting ability of qi, therefore it is said: "Qi is able to circulate blood." Furthermore, blood also relies on the containing ability of qi to avoid extravasation,therefore it is said: "Qi is able to contain blood." Because qi has
the abilities to produce, circulate and contain the blood, it is said:"Qi is the commander of the blood." Conversely, qi is dependent on the provision of adequate nutrition by the blood, therefore it is said: "Blood is the mother of qi."
In the pathological change, another concrete example of the
interdependence of yin and yang is the condition that "detriment to yin affects yang" and "detriment to yang affects yin', When the deficiency and detriment of any part of yin and yang reach to a certain point, the insufficiency of the other part is often induced. For example, in the syndrome of yang deficiency, when yang deficiency reaches a certain point, the production of yin fluid in the body is affected and yin also becomes deficient, because "without yang, yin
cannot be born". Most cases of chronic nephritis indicate yang
deficiency and are characterized by water swelling, because yang is deficient and fails to transform water. However, when yang deficiency reaches a certain point, the production of yin fluid is affected, and yin deficiency appears. This belongs to the condition that "detriment to yang affects Yin". Similarly, when yin deficiency reaches a certain peak, yin deficiency leads to simultaneous yang deficiency, because "without yin, yang cannot arise". This process is termed that "detriment to yin affects yang". For example, high blood pressure is often characterized by yang hyperactivity due to
yin deficiency. In the development of the disease, the condition may develop into the deficiency of both yin and yang, illustrating the description that "detriment to yin affects yang".The viewpoint of the interdependence of yin and yang also
can effectively guide the clinical treatment of diseases. For example,because of the interdependent relationship between qi and blood,it is advisable to apply the method to tonify both qi and blood in the treatment of blood deficiency. In profuse hemorrhage, because qi deserts with blood, it is necessary in the treatment "to benefit qi first in the case of blood desertion' in order to secure qi and to produce blood as well. Similarly, in the treatment of qi deficiency, it
is also advisable to combine with the blood-nourishing herbs properly,in order to have qi nourished by blood for the enhancement of qi tonification.
4) The interrestraint of yin and yang
The theory of yin and yang holds that yin and yang are mutually
restricted. The weakness of either yin or yang naturally leads
to the relative preponderance of the other; the preponderance of either yin or yang also leads to the weakness of the other naturally,so that the normal interrestraining relationship between yin and yang becomes lost, and hence the preponderance or weakness appears and disease arises as a result.
In physiology, the liver yin can control the liver yang to prevent it from being hyperactive. In pathology, if the liver yin becomes insufficient and fails to restrain the liver yang, the phenomena of the liver yang hyperactivity would appear, h the relationship between the pathogens and human body, the invasion of yang pathogens into the body will cause the preponderance of yang, which may lead to the damage to yin fluid and the appearance of heat syndrome. Conversely, after a yin pathogen enters the body, it will lead to the preponderance of yin, resulting in the damage to the body's yang qi and the appearance of cold syndrome.
In guiding the therapy, if the disease is caused by the heat pathogen, it is treated with cool or cold herbs according to the principle that "cold can counteract heat", meaning that the yin herbs combat the yang pathogens. Similarly, the disorders caused by the cold pathogens are treated with warm or hot herbs, since "heat can overcome cold", or the yang herbs can combat the yin pathogens.
This is the principle of treatment that "heat is treated with cold, and cold is treated with heat". It is often applied in the excessive syndrome characterized by the preponderance of either yin or yang.
In the conditions caused by the weakness of either yin or yang, it is because that one part is insufficient and cannot control the other,causing the relative preponderance of the other part. If yin be comes deficient and fails to restrain yang, leading to yang hyper-activity and deficient fire, yin deficiency is the cause, therefore the treatment cannot be given just by the simple method of draining fire and clearing heat. Instead, it is necessary to enrich the insufficiency of yin and the relative hyperactivity only can be restrained
by the method of nourishing yin and decreasing fire or the method of fostering yin and subduing yang. If yang becomes deficient and fails to restrain yin, leading to "the internal preponderance of yin cold", yang deficiency is its real cause, therefore the treatment cannot be given just by the simple method to disperse the cold pathogen.
Instead, it is advisable to nourish the insufficiency of yang and yin cold only can be dispersed by the methods of assisting yang, benefiting fire and tonifying qi.
5) The mutual transformation of yin and yang
The theory of yin and yang holds that any of the two aspects
of yin and yang can be converted into its opposite when it develops to a certan stage, i.e., yin can be converted into yang, while yang can be converted into yin.
The viewpoint of the mutual transformation of yin and yang
is mainly to manifest the chai~ge of syndrome, i.e. the conversion between yin syndrome and yang syndrome. When yin syndrome converts into yang syndrome, the concrete manifestation is that the cold syndrome converts into the heat syndrome and the deficient syndrome converts into the excessive syndrome. When yang syndrome converts into yin syndrome, the concrete manifestation is that the heat syndrome converts into the cold syndrome and the excessive syndrome converts into the deficient syndrome. For example, infectious hepatitis in its acute icteric stage usually manifests the excessive syndrome of damp-heat in the liver and gallbladder by yellowish complexion and eyes, fever, nausea, vomiting, pain in the hypochondrium, stuffy chest, poor appetite, thick-greasy tongue coating, However, when the condition becomes chronic and turns into liver cirrhosis, the deficient syndrome such as spiritual
lassitude and general lack of strength, dizziness, insidious pain in the chest and hypochondrium, no enjoyment of food and a dark-red tongue can be seen. This indicates that the excessive syndrome converts into the deficient syndrome. If the condition develops further, ascites can be caused by the accumulation of water-damp, manifesting as distension and fullness in the chest and abdomen.This shows that the condition has reverted from the deficient syndrome to the excessive syndrome. But, the resultant excessive syndrome is different from the original one. The initial condition belongs to the excessive syndrome in which although the pathogen is strong, the anti-pathogenic qi is still relatively unaffected, whereas the resultant conditio~ belongs the excessive syndrome of the deficient body constitution in which the anti-pathogenic qi has been
affected due to the strong pathogen.The above-mentioned viewpoints in the theory of yin and yang are not isolated. They are mutually related and mutually influenced.
In both the theory and practice of Chinese medicine, only by the correct comprehension of the basle contents in the theory of yin and yang, can it be possible to apply the basic viewpoints in the theory of yin andyang adapatably for analysing the clinical symptoms, identifying the patterns of diseases, deciding the principle of treatment and choosing the therapies and herbs more reasonably and properly.
1.2 The Theory of the Five Elements
The theory of the five elements holds that all the phenomena
in the universe are composed by the movement and mutation of
the five objects: wood, fire, earth, metal and water. In the theory of Chinese medicine, the attributes of these five objects such as wood, fire, earth, metal and water are deduced abstractly, by the assistance of the interpromoting and interrestraining relationship existing among these five kinds of objects, to explain the physiology and pathology of the human body as well as their relationship to the outside environment, so as to guide the diagnosis and treatment.
1) The characteristics and classification of the five elements
The theory of the five elements generalizes abstractly the
different characteristics of the five objects: wood, fire, earth, metal and water, to classify the internal organs and tissues into the five elements respectively by analogy and to explain the physiological characteristics of the zang-fu organs by the nature of the five elements."Wood is the bending and the straightening", having the characteristics of growth, upbearing, and effusion.In terms of the physiological characteristics of the five zang organs, the liver likes orderly smoothness and governs upstirring
and motion and it has the dredging function. It is similar to
sprouting of trees and plants, so that the liver is classified into the attribute of wood. Analogically, the organs and tissues which are closely related to the liver in the physiological functions, such as gallbladder, eyes, tendons, are also classified into the attribute of wood.
"Fire is the flaming upwards", having the quality of heat tern,
perature and upward motion.
In terms of the physiological characteristics of the five zang
organs, the heart governs the blood and vessels. It has the function of propelling qi and blood to warm and nourish the whole body.
It is similar to the characteristics of fire in heat temperature and upward flaming, so the heart is classified into the attribute of fire. At the same time, the small intestine, tongue and vessels which are closely related to the heart in the physiological functions are also classified into the attribute of fire. "Earth is the sowing and reaping", representing the planting and harvesting of corps and the bringing forth of phenomena'
In terms of the physiological characteristics of the zang organs, the physiological function of the spleen is to govern the transportation and transformation of the essence of water and grain, and the spleen is the basis of the formation of qi and blood. It is similar to the characteristics of earth in the bringing forth of phenomena, so the spleen is classified into the attribute of earth. Furthermore, the stomach, mouth and flesh which are closely related to the spleen
in the physiological functions are also classified into the attribute of earth.
"Metal is the working of change", having the qualities of puri-
fication, elimination and contraction.
In terms of the physiological characteristics of the zang organs,the lung likes to thrive by purity and governs descending. It is likened to the clear and pure climate and to the contraction of all the things in autumn. The autumn belongs to metal in the five ele- ments, so that the lung is classified into the attribute of metal. Besides, the large intestine, nose, skin and hair which are closely related to the lung are also classified into the attribute of metal.
"Water is the moistening and descending to low places", having
the qualities of moistening, downward movement and coldness.
In terms of the physiological characteristics of the zang organs, the kidney is to store the essence and governs tile water, it is similarly to the nature of water irt downward movement and moistening, so that the kidney is classified into the attribute of water.
Simultaneously, the bladder, ears and bones which are closely related to the physiological acitivities of the kideny are also classified into the attribute of water.
2) the interpromotion, interaction, overaction and counteraction of the five elements
The theory of tbe five elements is to explain the relationship
among the objects by the interpromotion and interaction of the
five elements.The order of the interpromotion in the five elements is:Wood --~ Fire --~ Earth --~ Metal -,- Water -~ Wood
In accordance with the principle of the combination between
the five elements and five zang organs, the order of the interpromotion in the five zang organs is:
Liver --~ Heart --~ Spleen -~ Lung -~ Kidney --,- Liver
The order of the interaction in the five elements is:
Wood --~ Earth --~ Water --~ Fire --~ Metal --* Wood
In accordance with the principle of the combination between
the five elements and five Zang organs, the order of the interaction in the five Zang organs is:
Liver --* Spleen--~ Kidney --~ Heart -~ Lung -~ Liver
The viewpoints of the interpromotion and [interaction in the
theory of the five elements can be used to explain the internal relationship among the physiological functions of the zang-fu organs and tissues of the human body. For example, the essence of the kidney (water) is to nourish the liver, the liver (wood) stores the blood to support the heart, the heat of the heart (fire) is to warm the spleen,the spleen (earth) transport and transform the essence of water and grain to supplement the lung, and the lung (metal) clears and descends downwards to support the kidney water. This indicates the relationship of the interpromotion among the five zang organs. For
another example, the clearing and descending abilities of the lung qi can inhibit the hyperactivity of liver yang; the orderly smoothness of the liver can dredge the stagnation of the spleen; the transportation and transformation of the spleen can stop the overflow of the kidney water;the moistening ability of the kidney can prevent the heart fire from becoming hyperactive; the heat of the heart can restrict the
overactivity of the lung in the clearing ability. This indicates the relationship of the interaction among the five zang organs.
In matter of fact, the overaction and counteraction in the theory of the five elements reflect the "interacting" phenomena under the abnormal circumstance and can be used to explain the pathological conditions in Chinese medicine. For example, when the liver disease is transmitted to the spleen, it indicates that wood overacts earth. When the spleen disease affects the liver, it is described that earth counteracts wood. When the liver and spleen are sick simultaneously and mutually affected, it is described that wood is stagnant and earth is deficient or that earth is obstructed and wood is stagnant. When the liver disease affects the heart, it is called that the illness of the mother influences the son. If the lung is affected, it is said that wood counteracts metal. If the kidney is affected, it is called that the illness of the son affects the mother.
The liver disease is thus explained, so do the pathological conditions of the other organs. The mutual influence in their pathology can also be explained by the relationship of the interpromotion, interaction overaction and counteraction of the five elements. In summarization, the theories of yin and yang and the fivem elements are a philosophic thought in ancient China and belong to the Scope of the simple materialism and spontaneous dialectics.
The theory of yin and yang is supposed to explain the mutation
and development of the objects by the mutual opposition, inter-
dependence and intertransformation of the two aspect of the object. The theory of the five elements is to explain the nature of the objects and the relationship among the objects by the attributes of the objects in accordance with the classification of the five elements and the laws of the interpromotion, interaction, overtion and counteraction,
In Chinese medicine, the theories of yin and yang and the five elements are used to analyse, study, summarize and explain the
physiological activities and pathological changes, with the zang-fu organs and meridians as the objective bases and by the change of the natural phenomena, to guide the clinical diagnosis and treatment. In the practical application, the theories of yin and yang and the five elements are often mutually related and cannot be isolated. The combination of the theories of yin and yang t nd the five elements not only can explain the ordinary relationship between the two opposite aspects of the object, but also can explain the comparatively
concrete and complicated relationship of the mutual influence and mutual restraint among the objects, so that it is benefitial to the explanation of the complicated life phenomena and pathological process.

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